Astromedicine has a surprising amount in common with working in the bush.
Any doctor going to space must be able to deal with extreme isolation and constrained resources while managing a whole lot of clinical risk.
Luckily for our astronauts, generalists working in the remote reaches of Australia are already doing that, or so says soon-to-be ACRRM registrar Dr Vienna Tran.
Dr Tran, currently in her second post-graduate year in Mount Gambier, South Australia, hopes that studying rural medicine will set her up for an eventual mission to the stars.
“More and more people in numbers and in diversity of bodies and ages and abilities and backgrounds … are going to space than ever before,” she told delegates at the 2023 Rural Medicine Australia conference.
Previously, astronauts have had to be among the fittest, healthiest people on earth in order to qualify for a space mission.
“Where humans go, on whatever voyage or journey, healthcare must follow,” Dr Tran said.
“In fact, events like arrhythmias and renal colic have already been documented in space on the fittest and the healthiest people on the planet.”
With the advent of private space travel opening up the possibility for laypeople to enter orbit, those events are likely to increase.
The thing is, Dr Tran said, space is so inhospitable it might as well be actively trying to kill humans.
Her research to date has focused on musculoskeletal degradation, since zero gravity deprives muscles and bones of neuromuscular stimulation.
“If we don’t use it, we lose it,” she said.
“So the density of the bone is going down, especially in the long bones, and the strength, the function and the size of the muscles goes down as well.”
It’s been thought for some time that the two hours per day of exercise that astronauts are currently recommended is not sufficient, especially with longer space missions like a three-year return trip to Mars on the horizon.
Without gravity, not even CPR works quite right.
“One way you can do CPR is you straddle the patient with your legs and then use your knees to push the patient up to you because you don’t have the gravity to push yourself down onto them,” Dr Tran said.
“Another way to do it is to push yourself off the ceiling of the spacecraft onto the patient.”
This last method kind of resembles doing a handstand on top of the patient’s chest.
Quirks of gravity aside, Dr Tran said, there are a lot of commonalities between rural medicine and space medicine.
“Space is high risk – there are procedures that you have to do in confinement with a limited number of perhaps untrained staff or staff with [limited training] and limited resources,” she said.
“You just can’t call on people quickly and you can’t fetch the bronchoscope from the nearest theatre.”
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