Intended for healthcare professionals

Career Focus

Welcome to the jungle

BMJ 2007; 334 doi: (Published 02 June 2007) Cite this as: BMJ 2007;334:s197
  1. Tilman Stasch, SHO in plastic surgery
  1. Norfolk and Norwich University Hospital t.stasch{at}


Tilman Stasch braves an expedition leadership course in the Costa Rican rainforest

Jaguar paw prints were visible in the mud outside our overnight camp in the Costa Rican jungle. Many of our group of 18 doctors had a restless night, struggling to be comfortable in lightweight hammocks. We used army issue ponchos to make roofs against the rain. We also had mosquito nets to protect us from bugs, spiders, and scorpions. This five day course organised by Expedition Medicine offered teamwork, leadership, and survival skills.

Tropical topics

Three doctors experienced in expedition medicine taught us core skills. The programme had interactive lectures on tropical topics and outdoor activities, which pushed us both mentally and physically.

Three hours of a bumpy bus ride and two hours of white water rafting later, we arrived in a beautiful camp along the Pacuare river in dense tropical rainforest. From here we did field excursions and learnt about treatment of various tropical diseases and common injuries. We spent some time away from the main base to set up camp beneath the canopy of rainforest.

Potions and lotions

Pre-course instructions meant we were well equipped with quick-dry shirts, trousers, bandanas, mosquito head nets, and various potions and lotions to protect us against malaria, dengue fever, botfly infestations, and other biting creepy crawlies.

But how could jungle strength DEET lotion (50-70%) protect us from the fer-de-lance (terciopelo), the most dangerous snake of Central and South America? This viper has a bite so deadly it frightens even the most hardened locals. On the first day of the course we visited the national serpentarium near San Jose and learnt about local reptiles. The fer-de-lance has been extending its territory from coast to mountains and has recently begun to breed twice a season, which is most unusual. These changes have been attributed to global warming. It is responsible for over 2000 snake bites a year in Costa Rica, five times more than a decade ago. If you survive its bite, there is still a 1% chance of death despite widely available antivenom. Amputations of limbs macerated from haemotoxic venom are common.

Jungle fever

After nearly four days in the jungle without encountering anything bigger than spiders and leaf cutting ants, we encountered a fully grown two metre specimen, curled up on the side of our narrow path winding down the steep mountain.

Head cocked. Ready to strike. We had learnt how to help a victim using makeshift stretchers, following a casevac plan, and contacting rescue teams via satellite phone. Luckily none of this had to be tested.


Canopy work

Teamwork is essential in extreme environments. Being constantly vigilant for each other's safety inspired camaraderie. Getting to know our strengths and weaknesses enabled us to complete allocated survival tasks.

Navigating through dense terrain demanded trust in the person leading us; crossing the river that we used to raft into our camp required intelligence, careful planning, and meticulous execution to avoid anyone being washed downstream. We learnt about ropes, carabiners, figure of eight devices, and harnesses. Our skills were tested in tree tops, where our so called canopy work consisted of climbing over 10 cm thin planks of wood, wobbly hanging bridges, and pulley rides along steel cables spanned across gorges.


Fear factor

When charged with securing my colleagues into harnesses on the pulley and steel rope to send them off on a 200 metre long ride high up in the air, I was reminded of the responsibility akin to doing my first unsupervised operation.

Late at night, with all members of the team safely back in camp, we enjoyed yet another delicious meal of traditional Costa Rican gallo pinto (beans with rice), fresh fruit, and ubiquitous cups of freshly brewed coffee. But we never did encounter the jaguar that must have been watching us bushwhacking through his beautiful forest.

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