{"id":297578,"date":"2020-05-06T16:47:59","date_gmt":"2020-05-06T20:47:59","guid":{"rendered":"https:\/\/news.harvard.edu\/gazette\/?p=297578"},"modified":"2023-11-08T20:21:09","modified_gmt":"2023-11-09T01:21:09","slug":"wilderness-medicine-fellows-return-to-lend-a-hand","status":"publish","type":"post","link":"https:\/\/news.harvard.edu\/gazette\/story\/2020\/05\/wilderness-medicine-fellows-return-to-lend-a-hand\/","title":{"rendered":"Applying wisdom from the Himalayas to the ER\u2019s COVID battle"},"content":{"rendered":"\n\t\n\t
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\n\t\tApplying wisdom from the Himalayas to the ER\u2019s COVID battle\t<\/h1>\n\n\t\n\t\t\t<\/div>\n\t\t
\"Himalayas.\"

Rohan Reddy\/Unsplash<\/p><\/figcaption><\/figure>\n\n\t

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\n\t\tAlvin Powell\t<\/p>\n\t\t\t

\n\t\t\tHarvard Staff Writer\t\t<\/p>\n\t\t\t\t\t<\/address>\n\t\t<\/div>\n\n\t\t

\n\t\t\tWilderness medicine fellows return to lend a hand in Boston\t\t<\/h2>\n\t\t\n<\/header>\n\n\n\n
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Brian Strickland was high up in the Himalayas, walking around a rustic clinic a day\u2019s hike from Mount Everest. He was trying to find a cellphone signal strong enough to get email and news from home as the coronavirus outbreak was evolving from being viewed as a crisis largely focused in central China to a global pandemic centered on the U.S.<\/p>\n

Strickland would be on a helicopter to Kathmandu within days, the first leg of his trip back to Massachusetts, where he\u2019d witness the rapid escalation of the COVID-19 epidemic from the intimate point of view of an emergency room physician. Within weeks, he\u2019d be heading a Massachusetts General Hospital (MGH) clinical trial exploring the use of inhaled nitric oxide \u2014 a therapy built on knowledge gained high in Himalayas \u2014 to rapidly kill coronavirus in the lungs.<\/p>\n

\u201cYesterday was my first full day off in a stretch of 10 days of shifts since I got back,\u201d Strickland said in early April. \u201cIt shows how quickly pandemics can completely change our lives.\u201d<\/p>\n

The turnaround was breathtaking for Strickland, who is in the first year of a two-year fellowship in wilderness medicine. The unique program, one of the nation\u2019s oldest, is headquartered at MGH and has a dual focus that seems made for the current crisis: training physicians to deliver medical care in extreme and low-resource settings, and fostering research around problems of low oxygen at high altitude.<\/p>\n

Founder N. Stuart Harris<\/a>, a Harvard Medical School<\/a> associate professor of emergency medicine and chief of MGH\u2019s Division of Wilderness Medicine<\/a>, has long studied the effects of altitude sickness and how to treat it in Everest climbers, whose final sprint to the 29,000-foot summit occurs in what climbers call the \u201cdeath zone,\u201d where air pressure and oxygen levels are too low for normal lung function.<\/p>\n

That work, Harris said, has led to the current clinical trial, leveraging insights from research done at high altitude to design a treatment that, should it work, would kill coronavirus directly in the lungs and allow patients to be discharged from the emergency department to home. The key insight, he said, is that the lack of oxygen at high altitude mirrors the effects of COVID-19\u2019s lung dysfunction on the cell\u2019s mitochondria powerhouse. It is also well-known that nitric oxide, which improves blood flow in the lungs, is central to adapting to life at high altitudes and has antiviral benefits.<\/p>\n

\u201cIf successful, this relatively simple therapy will give us the ability to treat and safely discharge patients from the ED to home, thereby reducing demand for the extremely limited supply of ICU beds,\u201d Harris wrote in a recent letter to the division\u2019s supporters. \u201cThis exciting work plays to our strengths of working in concert with the best minds on the planet to seek elegant and innovative low-tech solutions for complex problems.\u201d<\/p>\n

What makes a wilderness fellow?<\/h2>\n

Not every wilderness medicine fellow focuses on the hazards of the Earth\u2019s high places. Some devote their attention to the challenge of hyperbaric medicine, which treats scuba diving injuries, others to climate change, or life above the Arctic Circle. Harris said what\u2019s common among them \u2014 other than a love of the outdoors \u2014 is that they see human health as an ecological phenomenon that depends on a functioning biosphere and believe that expert medical care should be available wherever it\u2019s required.<\/p>\n

\u201cHealth care isn\u2019t an architectural phenomenon,\u201d Harris said. \u201cIt is about people. Wilderness medicine teaches doctors to provide compassionate, resource-limited medical care under austere conditions. A hospital is a box. We think outside the box.\u201d<\/p>\n\r\n\t\n\n\t

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Brian Strickland (fourth from left) with his research time.\t\t\t<\/p>

Photo courtesy of Brian Strickland<\/p><\/figcaption><\/figure>\n\t\n\t\r\n\n

Harris said by stripping away some of the things that have come to be viewed as essential in modern medicine \u2014 computers, diagnostic tests, an array of specialists who drop in for brief consultations and then are gone \u2014 fellows learn to lean on the relationship between doctor and patient.<\/p>\n

\u201cWe are a narratively driven species. In the back country \u2014 and the front country \u2014 the single most effective diagnostic tool we have is \u2026 the stories we\u2019re told and that we tell ourselves,\u201d Harris said. \u201cWe go outside to become better doctors inside.\u201d<\/p>\n

Though fellows can customize their experience, many, like Strickland, elect to spend a three-month climbing season at a clinic run by the Himalayan Rescue Association<\/a> in the village of Pheriche, Nepal. Overlooked by some of the world\u2019s highest peaks, Pheriche, at 14,000 feet, is on one of the main trekking routes to the climbers\u2019 base camp at Mount Everest. That means the clinic treats many foreign trekkers and climbers, not a few of whom are suffering from the altitude sickness that can result from climbing too quickly for their bodies to adjust.<\/p>\n

A starkly different place<\/h2>\n

When Strickland left for Nepal on Feb. 26, coronavirus was a concern, but the vast majority of cases \u2014 78,000 \u2014 were still inside China. Fewer than 3,000 cases had occurred outside the Asian giant, and many of those were in South Korea. The U.S. at the time had just 53, all but two of which had origins outside the U.S.<\/p>\n

Strickland spent a week in Nepal\u2019s capital, Kathmandu, getting oriented and taking Nepali language lessons focused on medical terms. At the end of the first week in March, he flew to Lukla, a small town with the airport nearest to his destination. After that came a four-day hike to Pheriche and the clinic at which Strickland was scheduled to provide care for the next several weeks. As he hiked, Strickland noticed that foot traffic from trekkers and climbers was far below that of a normal season.<\/p>\n

\u201cI could see, even in this isolated part of the world, even in the first week of March, the crisis was affecting them,\u201d he said.<\/p>\n\r\n

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\"Mountain<\/figure>\n\t\n\t\r\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\n\t\t\t
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Rural pathways through the Himalayan mountains.<\/p>

Photos courtesy of Brian Strickland <\/p><\/figcaption><\/figure>\r\n\n

When he arrived at the clinic on March 12, Strickland realized there would be far less demand for his skills than expected, and his research plans might be in jeopardy. The next day, the Nepali government confirmed that, halting all mountaineering expeditions and closing the country to tourists. Though just over two weeks had passed since he left Boston, the world had become a starkly different place. Coronavirus cases in Italy and Iran were soaring and those elsewhere in Europe were expanding rapidly. U.S. cases, meanwhile, had already topped 1,000 and predictions for the coming weeks were dire.<\/p>\n

Strickland realized that, while the Pheriche clinic would be unusually quiet, if the pandemic struck Boston in earnest, that would be the place \u2014 despite its biomedical sophistication \u2014 that would be short of resources and where physicians and other health care workers would be struggling to keep up with the flood of patients. After talking the situation over with Harris, he made the decision to return.<\/p>\n

\u201cWe do the training to go where health care providers are needed. There was a need that developed. I saw the situation deteriorating in the U.S.,\u201d Strickland said. \u201cI did the fellowship to do medicine in austere and resource-limited settings, and I realized that\u2019s what\u2019s happening back home.\u201d<\/p>\n

Homecoming<\/h2>\n\r\n
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More like this<\/h2>\n\t\t\t\t