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Fellowship Studies Wilderness Medicine

December 1, 2003

STANFORD, Calif. (AP) _ Dr. Eric Weiss bikes to work on a palm-studded campus far from bears, snowstorms and bone-crushing river rapids. But peril surrounds Stanford University’s assistant professor of surgery.

Manila envelopes labeled ``killer bees,″ ``malaria,″ ``parasites″ and ``drowning″ line his cabinet. The emergency room doctor plots lectures titled, ``arthropod envenomation,″ ``infectious diarrhea″ and ``wild animal attacks.″

Weiss, an altitude sickness specialist who helped build a Himalayan clinic at 14,000 feet, is founder of the nation’s first fellowship in wilderness medicine. Administrators believe Stanford’s one-year program, which began in July, will fill a demand for doctors in the emerging niche.

Several U.S. universities offer environmental medicine classes, and specialty schools from Appalachia to the Rocky Mountains train outdoor enthusiasts. A subspecialty of emergency medicine that includes travel medicine, trauma management, and plant and animal ailments, wilderness medicine even has its own quarterly journal.

Yet few research institutions have formal departments or programs in the field. Weiss, who teaches weekend courses popular with backpackers, hopes the Stanford fellowship will help change that.

``Eventually, I’d like to see every medical school in the country have a wilderness and environmental medicine division,″ said Weiss, a 47-yearold former whitewater guide who sports a salt-and-pepper beard and Timex Ironman watch. ``Wouldn’t it be great if every doctor knew 1,001 practical uses for duct tape and safety pins?″

Skeptics wonder whether many U.S. medical students _ particularly those saddled with student loans _ will pick a career path that leads to international relief work or remote rural clinics. But few question the need for doctors who treat maladies such as hypothermia, heat stroke, insect bites, bear attacks and the cardio-respiratory problems associated with scuba diving.

Although few hospitals keep statistics on the origin of outdoor injuries such as sprained ankles and concussions, medical professionals say more people are getting hurt as backpacking, diving and rock climbing gain popularity.

Nearly three dozen people have applied for the next fellowship, which requires completion of an emergency room residency. Administrators may expand the program to two slots.

Twenty-nine-year-old Arthur Kaminski, the first recipient of Stanford’s fellowship, specializes in scuba-related conditions. At least one in 100 divers experience decompression injury, according to Divers Alert Network.

As part of his fellowship, Kaminski, a trim blond who started diving in Lake Michigan, will spend two months in Belize, tending members of a National Geographic jungle expedition and conducting research in the Caribbean. He plans to chart changes in divers’ hemoglobin and enzymes, then measure carbon dioxide eliminated from different types of equipment.

``I got a zest for emergency medicine when backpacking in South America,″ said Kaminski, who once fashioned a splint from vines and bark for a traveler in the Amazon. ``I picked diving because I had to focus on something, but really I was interested in everything, from jungle survival to altitude illness.″

At the same time, Kaminski thinks few of his University of Chicago peers would consider the field.

The average medical student in 2002 graduated with $104,000 in student debt, according to the Association of American Medical Colleges. The salary gap between neurosurgeons or other specialized doctors and rural practitioners is often several hundred thousand dollars per year. Many work in relief camps or volunteer in war zones for Doctors Without Borders or the National Association for Search and Rescue.

Paul Auerbach, Stanford’s chief of emergency medicine from 1991 to 1995 and editor of the textbook Wilderness Medicine, emphasized that wilderness training applies to any medical situation.

Doctors who battled SARS in Hong Kong and treated burn victims in California’s wildfires were exercising improvisation and quick responses required of wilderness doctors, he said.

``It doesn’t have to be on the Arctic Circle or at the top of Mount Everest,″ Auerbach said. ``You could be stuck in Central Park, but the same skills apply whenever you have limited resources.″

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