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General practitioner Mieke Luten: ‘Expedition medicine only works if it is structural’.

During an internship, Mieke Luten took a course at Outdoor Medicine, the organisation that promotes international cooperation between paramedics with an interest in expedition medicine, wilderness medicine or medicine in extreme environments.

Surrounded by like-minded people, she was able to combine her passions in expedition medicine. Two years ago Mieke travelled to Panama and worked with Floating Doctors’ to remote villages of indigenous people.

Floating Doctors visits these villages every twelve weeks, for three to four days, in such creating a basic continuity of care,’ says Mieke. This continuity of care is important. Especially when it comes to providing contraceptives, for example, so it makes no sense to set up a one-off expedition. In my opinion, these kinds of initiatives have to be structural; developing a cooperation with the local population, whilst respecting their traditional methods. Floating Doctors aims to set up permanent posts and train the local population so that they can eventually provide this health care themselves.’

Demand-driven care
A clinic is set up in the common area of those remote villages. People live outside and meet in the Rancho’, an open enclosure. This is exactly what you imagine it to be: a roof on stilts, without windows or walls. The team sleeps in hammocks they bring in that space, and yes, even in the most remote clinics you still find coca cola and occasionally even a small generator, but at night it is pitch black and you are surrounded by kilometres of jungle. The provided care is demand-driven; we don’t come and tell people what they need. I think that’s very important.’

Once the clinic is set up, people form a queue and they visit us with their families or just on their own with their questions. Normally these consist of complaints or questions that we would also direct at our GP. Sometimes you come across unfamiliar things. For example, I saw a middle-aged man with a strange rash on his face. That can be difficult to assess as it could be anything: diet, contact with an insect or a plant… I was lucky that I was able to get a signal on my phone, so that I could consult a dermatologist friend via the Siilo app. He liked that, by the way. But, with limited resources at our disposal, we have to make do with what we have. So you actually discuss which approach has the best chance of succeeding for each specific situation.’

From Panama to Kenya
Mieke is now a GP and works in Diever and Zwolle. And yet, she has not let go of her Panamanian experience. First of all, I love being outdoors and active. The periphery attracts me more than the city. I started cycling via Lola Bikes & Coffee in The Hague and that’s how I got involved in The Amani Project. This is a project that combines initiatives to increase inclusiveness in cycling and to create meaningful opportunities for riders in Africa. Riders such as Nancy Akinyi, Sule Kangangi, Geoffrey Langat, Kenneth Karaya, Jordan Schleck and John Kariuki are good examples of this.’

Of course, this also includes international competitions on several continents. The Migration Gravel Race (MGR) in Kenya follows the route along which big wildlife migrates every year, a breathtaking route that is not without danger and in cooperation with the Maasai. It is a four-day stage race in which international riders such as Laurens Ten Dam, Thomas Dekker and Ian Boswell, as well as amateurs, participate. It has really become a wonderful event in a short period of time.’

Last year I took part in the first edition of the MGR,’ says Mieke. But I am still a doctor and I did provide medical assistance where necessary. You cycle at altitude, you exert yourself, there are race elements, so you encounter things like wounds, exhaustion and overheating. This year I will go along in an official capacity as an expedition doctor to assist the racers who push themselves to the limit, together with the local medical team. The event has gained international prominence and it is getting bigger. And yes, I might even get on a bike myself, and afterwards I will race in the five-day Evolution Gravel Race in Tanzania.’

Siilo is sponsoring and following Mieke Luten this summer during the Migration Gravel Race in Kenya, and during the Evolution Race in Tanzania. Follow us on LinkedIn (@Siilo) or Twitter (@siilomessenger) for news updates, blogs and pictures of these wonderful events!