Hello everyone and welcome to the Quorum podcast.
This is where academic medicine meets remote, austere and
resource limited areas. Welcome back to the podcast.
This is Avacol Kelly. This week we are again with Zach
Andrews, one of our Masters of austere Critical Care graduates
who impressed us so much we hired him on the spot.
Zach, welcome back to the podcast.
Hey a brick, thanks for having me on again so.
Tell us a bit about yourself and what's keeping you busy.
Oh, you know, I mean, I'm constantly, constantly working
on some projects, you know, bunch of educational things,
trying to finish up some projects.
For you guys. And working.
With Phil also to try to do the. The student success department
for, for the undergraduate programmes and graduate
programmes, you know, I always stay busy doing remote
paramedicine here in Texas and that's, it's kind of always
keeps me busy and learning and, and catches my eyes so.
It's that's how I. Stay stay relevant when when I
can't be out in the field like I want to.
So you've. Joined Phil Clark on the Student
Success Department, which sounds like an SF mission because it's
so vague it could be just about anything.
So tell us what? What do you do there?
Yeah, you know my role they're working with.
Phil is it? It's a.
Bit different.
It's a bridging role, it. It's a role where.
I'm not working for. The.
Professors and I'm not, I'm not necessarily working for the
students either. I'm working.
For the. Best outcome of everyone who's
going through there, you know, so.
I I guess. You know.
The best way to to to put it there.
Is I kind of bridge from? The student body to the
professor body. And I I helped, kind of.
Tie that together. To make.
Sure that both are. Meeting the needs of each other
and understanding each other and the roles and in that.
Super broad. Within it I I wish I could kind
of. Say that better but.
You know, it's, it's making sure that the, the students are being
challenged, which they may not want, but they, they need to
become, you know, as professional as possible, but
also make sure that they're being enabled to, to reach that
goal. And so it's, it's a dynamic
position where you kind of play on both sides of the line.
And I really like it. So you hit the ground running.
You sent out a student satisfaction survey.
What did you find out about our student programmes?
You know the student programmes, what came out of.
There is high value. And pertinent instruction, you
know, and so the students. Really like that.
This is a A. Programme that hits that
medicine, you know, that's its focus and and that's what they
want and they feel. That it has high.
Value into the field experience and and as clinicians.
It it it grows. Them and on the other.
Side of that too, though, there's also difficulties.
You know, Korom has a very unique approach to make.
School affordable. And it's not.
Full of full. Time staff, everybody isn't
sitting there, you know, working in a a building and with.
With full. Classrooms and you know.
Teacher's aides. And secretaries and all these
things that make university so prohibitively expensive,
especially, you know, as we're going here in the US.
And so because of that, you know, there's a little bit of of
dynamic that the students have to to learn and the college has
to meet midway on within being a bit.
Of a self starter. With programmes and having to
maybe not having as much contact and direct instructions for
everything, especially within that European mindset of, hey,
we're giving you the baseline and we want.
You to explore past these topics.
And we want you to professionally grow.
As you're, as you're. Taking these courses and so
that. That's a bit.
Of a challenge for a lot of students to get is many
countries, including the US. Here in the US, we tell you.
Exactly what you we. Want you to know, in an
undergraduate programme we we don't care if you do any
exploring, we actually would. Prefer you to to just.
Read and. Study purely what were.
Put in front of you, which is. Good, but it.
It makes you proficient, but it doesn't make you a student of
the medicine. It just makes you, it, it makes
you regurgitate the medicine that was given to you.
And so it, that's a difficult mind shift for, for students to
pick up. And it, and it took a minute for
me to, you know, it felt like you're going through school
without a safety net. And so we're trying to find
ways. Where we keep that?
Great enhancement of learning. But also.
Helping the students through that process and not feeling
kind of out there alone in in the.
Sea of of scholarly work. I like the fact that all of our
faculty are clinicians. They they practise and they're
not full time with the college. Yes, yeah.
It in it's, it's incredible because it, it's relevant, you
know, you don't sit there and, and talk to somebody who said,
well, you know. I've I've read.
Articles I'm up to date on medicine, but I've not done this
in 15 years you know, you talk to them and sometimes you get a
reply e-mail that says, hey, be patient with me I'm out doing
this work, you know, and it's like what that's kind of neat
you, you know, your, your relevancy is, is today not, not.
Years ago, which is? Common with a lot of programmes
you go into. That allows us to not be overly
expensive. I was I paid $35,000 for my
master's degree in the US 20 years ago and I got cross that
it was that much and and what I got from it.
So by starting quorum, I put it into motion that this whole
concept of no one works full time at this point anyway and
everyone must be clinical. Yeah.
And that that's, that's what I I think.
Is the the beauty? Of Co ROM and the you know the
cost of school nowadays we we limit education purely by cost
and I, you know compare my degree with Co ROM to.
My my brother's. Degree here in the US and he,
he, he got, it's a masters of business.
So it's, it's a bit different, but it was again online.
He, he never went in person at all.
And I I don't know the exact numbers, but it took him about
18 months to complete and it was somewhere between 45 and
$60,000. Which is outrageous to.
To think that. That's what people are.
Putting into 818 months worth of school.
Yeah, so charging 10,000 for our master's degree means that we
don't have enough money to pay our faculty full time.
But I want that because it forces them to also be
clinicians. Yeah, and I think, you know, the
faculty, you end up kidding. It ends up not somebody just
trying to put, you know, to get them through from.
Paycheck to paycheck. And working a job because they
want to, but you end up getting. Faculty that.
Have a passion for this, you know as as working with Phil.
Clark, I I. I receive no pay to do the
student success and and I do it. Pure out of of.
Passion just because I want to help these other students who
who want the same thing that I wanted a good quality education
that focuses in the austere medicine realm.
That is. Affordable and applicable.
So Zach, now that you are part of the student success
department, what are your plans for improvement?
How can we make quorum better? Yeah.
So within the survey, you know, there's a few tweakings that I
found that we can do. To our courses.
And some of it's. Just a little.
Bit more clear guidance and expectations and I think all
that works going on right now. I know the.
The Bachelor's. Programme had a big meeting to
kind of. Level the wave tops.
And make sure that everyone's getting on on the same page with
that and you know the other. Piece that we had.
Too is just communication I. Believe the the staff side of
the college. Did a tremendous amount of work
already and created. SOP's or protocols to to.
Align the communications better with students and I know some of
that went from multiple. Days.
Before students would get. Replies.
To most of the replies now seem to be.
Day of. Or next day and including
enrolling students much quicker and getting them set up much
quicker than before. Because of your feedback from
your surveys, we have changed things on the back end anyway.
And Chabadiya Segi, who is now our Chief Operations Officer has
has implemented changes for returning emails for for knowing
where students are and being better at some of the
deficiencies that you found with your survey.
Yeah, he's. He's done a fantastic job.
I mean he, he. He he has a a professor was was
great. I mean, he was clinically
excellent, loved interaction with him.
But his leadership abilities? Coming through was was amazing.
It was almost unexpected because not every physician has.
That ability to go. From great clinician to leader.
But he took that. And with without really any
prompting, I mean he, he just. Looked at the survey.
And just ran with it and is is creating, created and is
creating, you know extreme change within the college and I
was. Happy to see that.
It was good to know from my side and and good for me to.
Be able to relay back to the. Students of Hey, you've, you've
been heard, you know, we're not going to ignore what you're
saying. And there's there's action
happening today. So looking back over the decade
that Quorum has been open running, we have spent so much
for focus on the hands on the classroom, the the what you're
doing in Malta and with your input.
Now we're looking at the back end of that as well to improve
the students experience with the emails, with the the contact
with direction for what to study and how to study.
Yeah. And I think it's always going to
be a circular kind of pattern that we do, which is good and I
think as. We we get the the.
Back end fine-tuned. I can already.
See the the. Instruction side in the.
The Malta side. Probably already looking at ways
to tighten down also, and I'm sure in you know the next.
Couple years, we'll be back to the.
Back inside and. So it's the the good cyclical
process that. Any institution needs needs to
be doing. So Zach, a fortnight ago we had
a chat during the quorum conversations about setting up
IC US and rough environments in remote and austere areas.
Tell us a bit about your experience.
You have a profound amount of experience of doing this, so
tell us what have you learned? What are some things we need to
know about setting up an ICU in very odd and difficult places?
Yeah. So that's truly.
Where my passion? Arose for critical.
Care medicine. I was lucky enough that I spent
years in the jungles of Central Africa, very much away from any
medical system that, you know, would, would compare with, with,
you know. The the UK or or Europe or the.
US, you know, Canada and any of those and then I also got to
spend a significant amount of time in.
Southeast Asia. And and that's a little bit
different, a little bit more built up, but still many of the
same principles are going to. Apply there.
And so one of the biggest things is when you go out there, you
need to understand your remoteness and how.
Few resources there really. Are in the extreme measures it.
Takes to get a resource. To you and it's not just
distance many times it's it's just it's weather you know the
the rainy season in Africa can take down any.
Possibility of aircraft. Making it up to.
You it's actually quite difficult for.
That and so the planning aspect if you want to be out there.
Is really where? You go from well, I packed my
meds and things like that too, and now I'm doing a full history
on everybody who's going with me.
I'm looking at all the the different chronic.
Diseases that they have. Any, any medications that
they're on any, any possible, you know, issue with the
patients that you might encounter there.
Because the reality. Is is things like?
Surgery or or. Even you know diagnostics in a.
Lot of these places. It is non existent and so.
You have to, really. Know that these patients are put
on you and the other. Aspect is OK.
Those are my patients, but now I need to understand my system and
so. You have to start.
Looking at reports of the medical facilities that that may
be within reach in, you know, you may go to some of these and
you walk in and you go. Oh, I.
I'm not going to allow my, you know, my team to be, you know,
treated long term. Here, but there's still
capabilities that they have. And you know in.
Africa, there's a lot of places that.
Do very good microscopy, you know, even in the rule points.
And so those may be something that you, you know, you utilise.
And then there's the. Places where?
OK. If I do take someone to.
Surgery. Where do they?
Go and what surgical capability can actually do in those places
and if if you're remote enough you may be saying you know like
I was as. If I get a.
Patient out of here. How do I get them out of here?
You know, 911 or 000 or. Wherever you're.
At doesn't quite exist in those places and in the cost of an
emergency evacuation is is extreme sometimes up into you
know 400, you know 500,000 you and so insurance is actually one
of the things that you request. People.
To get on to. Have the the travel.
Insurance and to, to be linked with a company like
International SOS or you know, not a plug for them.
There's many others. I've used them before, but
there's many others that are good too.
But you're going to want to make sure that you even have that
insurance information. Ready to go?
And that way when you call, because they're not going to
start spinning up their partners unless they're going to get paid
or unless your company is going to just pay the upfront.
Cost of it so. Depending you know.
Perhaps how big if? You're doing a Nat Geo mission
I'm sure they have you know all types of things with them and
and another thing is actually cash on hand many.
Places you go to. You don't get the guaranteed
emergency treatment that you're going to get if you go in many
countries emergency, you know departments will.
Treat you regardless. They're going to do life saving
intervention many of these countries.
They'll actually. Put you on a bed and put you on
the side and wait for some form of payment or check your.
Pockets for cash first. And so you know, even something
as simple as that as bringing. Cash for every.
Patient to get treatment started if if you need to even something
you know as life saving as a blood transfusion is isn't going
to happen with without payment and then you get into.
Where you really grow. As a paramedic and I've kind of
lined this out with. People before.
You know, as we're seeing the. Career field grow.
You have advanced paramedics. Who who have this?
Extended pre hospital. Scope but.
Really when you get into the paramedic practitioner range is
is where. We start.
Diagnosing and in treating things that are really not life
saving, you know, but more more encountered microbials and
things like that. And so your Tropical Medicine
has to be on point and in further.
Understood with the last. Diagnostic resources you have
and I had many a septic patient due.
To what we. Had and I had traumatic patients
also due to, you know, different could have been a motor vehicle
accident. Or or whatever had occurred, but
those. The more difficult ones are
really those septic patients due to microbials, and some were due
to malaria, some were due to these, yeah, just unknown skin
infections that we had. I had one patient with a
cephalic presentation of the bubonic plague, which is.
Really rare to. See, I mean that's a minority of
a bubonic plague patients that you even can see and you.
Have to be ready to start. Diagnosing and treating those
patients and you know, with the. Best of what you.
Can is is needing a clinical picture and treatment plan
together even if you can't? Treat to its fullest.
Extent to get that going and then you're going to encounter
things like the wildlife. That's out there.
You know the microbial? Sure they may.
Be the we beasties, but the big beasties are out there also.
And snakes were a significant problem.
Ran into many boomslangs. We had green mambas.
We had puff. Adders.
I mean, we had some of the deadliest snakes around us and
being. Ready to to treat.
Things like that. We're also a significant part
into what you need to look into. And so you really start going
from a domain of emergency medicine and opening up to all
the domains. And one of the the biggest to
grasp onto that we're really not taught as paramedics is getting
into preventive medicine. You know, if you're out of camp
long enough, well, where? Where do?
You, you know, urinate at where do.
You. Wash your hands.
Where do you? How do you deal with trash for
food? You know, and there's a lot of
things that people don't think of you.
They'll think of flies, you know, of course, and disease
transmission from from flies. But flies being frogs, and frogs
bring. Snakes in the flies bring.
Diseases as. Everyone's probably already
thought in their head too or. If you have trash out, the trash
will. Bring field mice.
You know, the field mice seem to be all over the world and this
field mice bring other snakes and predators and things like
that in And so it's a complex situation that you get yourself
into and you need to. Be ready.
To on the medicine side, now you know what, what everyone most
wants to focus on is managing a patient and having a full
understanding of what is going on with your patient with
minimal resources. And you know, even I was lucky
enough many of times to have an I.
Stat where I could pull labs that were pretty.
Significant compared. To what we're used to, but OK.
When you get the labs, what does that mean and what are you going
to do at that point? You know, So yeah.
There's there's. So many lessons learned.
It was really. An educational experience for me
through those years and one of the the most profound
experiences that really changed my medicine.
I would not trade those experiences for anything.
You mentioned the a medical intelligence assessment or, or
just doing a map survey before you get there.
I, I remember on the OD as there in first bench rewards group we
would have an advon an advanced party to physically go and look
at the local hospitals. In this the Street View you
would see of this hospital, but we didn't have it back then, but
now you can see Street View. It might look good but it might
be rubbish. So you do need to have the the
hands on, don't you? You you do.
Actually, there's many surgical. Suites.
I'll I'll use that loosely. I.
Walked into that had one particularly had broken tile on
the floor and actually when you when you walked on it.
You could see the. Dust being kicked up in the
sunlight in the picture. Of it that was.
Online look great, it must have been a picture right when they
first built it and that would have been.
Perfect, but at this. Point then you get in there and
you go yeah, I there's not much I really want my team to get
done here you know and so at that point you really have to
limit of well they have. Surgical capability, but.
What's What's going to be my backstop?
Of depth I allow because the. Complications of the dust in the
air, the you know, what is that going to do?
And you have to go look at everything with them.
How do they sterilise? Equipment, you know, how do they
store their medications? It's a whole new aspect to get
into and. It's it's very.
Time consuming and. It has a.
Bit of of a political sense. With it too.
In, in the sense of you're going to assess them and your people
skills and, and speaking with them have to be good and, and
have an understanding of, of what they can do in, in what you
may need them to do is going to be there too, because a lot of
times as as a westerner, A physician or whoever going to
these. Places they're actually they're
proud to take you. Around and show you everything
and they're they've worked very. Hard to get the.
Place in the situation as it is and they don't want you to go in
there and and tear them down by by any means.
And so you, you kind of have. To to be.
Polite while you're in there and respect that.
It may not be perfect, but they're working hard too.
Zach, you mentioned preventative medicine, you mentioned
dermatology, you mentioned primary care.
It it sounds like setting up a jungle ICU you need to be a Jack
of all trades. You do.
You know, you need to be a Jack of all trades and and that's
quite difficult right now. With the way we.
Focus and we do medicine you don't have.
Jack of all trades. You know, back in the day, you
know, 60-70 years ago, a primary care physician, you know, many
of them would do surgeries, you know, more on the minor side,
but they'd still do them. And, and we don't do that now.
If you have, you know, we have entry ways to medicine.
If you're a General practitioner or family medicine, there's a
limit and then they send you to a specialist, and that's not
really the capability that you're going to have there.
And I know the saying is, you know, you know.
Jack of all trades. Master of of none, but in in
there's kind of a negative. Or positive.
Depending connotation how you look at that, but you're going
to have to self. Evaluate where your gaps are to
be that Jack of all trades. And you know, that's there's
multiple places that that can be, you know, I talked about the
preventive medicine, the medical intelligence side, the the
primary care. Side but if you're.
You know those exist. For if you're a.
Nurse that's going out, you're going to have multiple.
Other sides, too. Many of the same and physicians
you're going to have other sides too.
You may be better trained in epidemiology and preventive
medicine, or you know. Had had that because of a rural.
Medicine focus. But you know, the medical
intelligence probably wasn't hit on very much.
And then you know how, how are you going to perform the lab?
Tests that you. Would normally just order, you
know, microscopy. How do you?
Do that. What do you use?
As your your mordant and your fixer and, and what do you take?
What do you, what do you not take?
Or are you just going to use rapid diagnostic tests?
You know, there's there's a. It's it really?
Is it? Becomes this this mountain of a
problem and those that are brave enough will really like it.
I mean, I I thoroughly enjoyed that I was challenged in
multiple ways to make a cohesive medical picture.
Zach, what did you learn on the Masters of Auster Critical Care
that addresses some of these issues?
Well, you you for. Sure are going to deep dive into
the medicine piece of it and a lot of times you you don't know
what you don't know and I know. That's that's a silly.
Saying and I used to have a friend which.
Would say of. Course, you don't know what you
don't know, but it really opens you.
Up to the. Vastness of medicine and within
the masters and allowing you to to not just say only.
Read this but to. To dive into, wade through the
medicine. You start to pull.
Deeper and deeper aspects. To to.
Bind some of those domains together.
You know and. You also start.
Talking about things like prolonged care and our prolonged
field care, whatever you know that the term you want to use
for it is and especially within that.
You start to see. Multiple difficulties and
realities. To it.
And. There's a whole block.
On Tropical Medicine, which I highly recommend and actually.
There's a graduate diploma. On Tropical Medicine, which I
really recommend through the through the college and that if
you've never. Really.
Looked into Tropical Medicine that's going to open your eyes
to how much more is out there that you're not familiar with
much of the the temperate medicine.
You know, if you're in the US and you say influenza, well
everyone's very familiar with that, even non medical people.
But if you start. Talking about schistosomiasis,
you know, one of the many things that's.
Out to people go what? Well, that's been about.
Everybody of. Water that's out in, you know,
the continent of Africa. So now you start to.
Go oh. And it's this whole other domain
that I've really not reached into in with that you learned
the life cycle. Of.
Diseases and you know, and it starts opening you up into how
you can be truly. Effective there versus just?
Being there and treating emergencies and and
symptomatically you break into that practitioner role a bit
more. So, Zach, at the end of this
month is SOMA Special Operations Medical Associations Symposium,
one of my favourite weeks of the year.
You're you will be presenting the Medic of the Year
scholarship. Can you tell the listener about
that? Yeah, the medic.
Of the year scholarship, which is.
Which is. It is great.
It's it's up, it's a prestigious.
Award for the medic. Who?
Who gets it? And.
What they do is across special. Operations medics in the.
US they. Everyone nominates a candidate.
To to be. The medic of the Year and
there's this committee that that.
Picks it. This individual and the College
of Remote and Offshore Medicine does it has a fantastic
scholarship that is given to this individual and I've no clue
who it is. I don't think they've released
it. I'm sure they.
They hold that very tight, but they get a free scholarship for
the. Masters of austerior critical
care programme, which is phenomenal.
I mean such. Such a great value to to be able
to get. In in very, you know, very neat
for the. School to to honour.
Somebody that way and and recognise.
Their their ability. Within medicine and and to.
Be able to to. Allow them to go.
Further so. You know I.
It's pretty. Exciting.
That a school is. Giving something like that to
the awardee. And you'll be the one presenting
it. Yeah.
So, yeah. And I.
Will I'll be the? The one presenting it.
So happy. Happy to do it, happy to keep
keep a good. Relationship between US and and
soft medics I know that's been the college has.
Has a pretty. Rich background of supporting
soft medics you know worldwide and and especially.
With with your. Background that.
Has of course. You know, been the foundation.
For that so. So I thank you.
For for. You know, really starting the
culture. Of that support.
Zach, my final question for you is this.
What advice do you have for the new medics, the new nurse, the
new Doctor who is just starting out in their career in austere
medicine? You know, I don't know if my
answer has changed from the other podcast here.
You know, be brilliant. At the Basics The basics get you
out of trouble. That the fancy stuff would have
to be employed for being brilliant at the basics, you
know, if we go back to the domains of, you know, the basics
of preventive medicine, the basics of medical intelligence,
the basics of, you know, primary care and emergency treatment,
the. Basics of all those.
Is what's going to keep you from having to have this outlandish,
you know, a treatment plan and and I know some of us that's
kind of what we crave we we want to do those those things, but
you don't want to do that in the remote environment A new fear is
unlocked when. You call for help.
And nobody's coming, not in any, you know, decent amount of time.
So focus on those basics. Look at the basics.
Across all the domains. Wherever your specialty is good
at, that's great. Look where.
It's not good at and make sure that you spend some time there.
Zach, it's fantastic to have you on the podcast again.
It's fantastic to have you on our faculty and thank you for
being our guest today. Absolutely a.
Brick, thanks for having me on. This has been a presentation
from the College of Remote and Offshore Medicine.
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can join. The Council of members.
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