As the world prepares to send people back to the Moon, and even deeper into space, we need to start thinking about how astronauts are going to stay healthy – because if they don’t, it might not be nice.
At the moment, if there’s a medical emergency in space, the best response is just to evacuate the person to Earth.
But if you’re headed to Mars, it could be months before you make it back home. Such journeys are going to need a doctor to keep their voyagers healthy.
What sort of physician?
“I can’t think of anyone better suited than an Australian Antarctic doctor,” says Dr John Cherry, an Australian Antarctic doctor.
In Antarctica, medical evacuations can take anywhere between two weeks in summer and nine months over winter. Rescues in winter are rare.
But the time and difficulty of getting home isn’t the only similarity between Antarctica and long-haul space flights according to Cherry, who is a space medicine researcher as well as an Antarctic medical practitioner with the Australian Antarctic Division (AAD) and fellow of the Australian College of Rural and Remote Medicine.
“Antarctica is a well-established space analogue environment,” he says.
“It’s small teams, operating in an extreme environment with extremes of temperature, completely dependent on technology for survival, with alterations to their circadian rhythm.”
Both the physical and mental stressors are similar.
“One of the common things that you’ll hear astronauts talk about when they return from the space station is how there’s sort of a chronic, constant, low level of stress from listening out for the alarm,” says Cherry.
“We experience the same things in Antarctica. We’re constantly on the alert for alarms which could impact our ability to survive in that environment.”
Each of the AAD’s four Antarctic stations has one doctor living there over winter. Cherry was the Davis Station’s doctor last year.
“That doctor is responsible for all of the generalist medical, surgical, anaesthetic and dental care of their team.
“They also run all the pathology, or the radiology. They keep the facility clean, they do stock-taking. If someone’s sick, they also nurse the patient as well.”
While this sounds like a lot, it’s not just Antarctic doctors who do this. In fact, this type of work mirrors a “rural generalist” model: how doctors in remote parts of Australia operate.
“Rural generalists are GPs by training, but GPs trained to work in rural and remote Australia,” says Cherry.
“They have many of the skills that are ideally suited for both the Antarctic setting and also this long-duration space flight setting, where you have to be a jack of all trades, so to speak.
“The doctor has the telemedicine support from the head office team, but is ultimately the sole practitioner on the ground.”
Telemedicine is a crucial part of this model: while there’s one person who is directly taking care of you, in both Antarctica and remote Australia, they’ll have lots of contact with specialists who can help.
This is particularly important for common issues that doctors wouldn’t normally be highly involved with – like dentistry.
“I think I had one lecture on dentistry in medical school,” says Cherry.
“Dental issues are some of the most common issues that expeditioners experience down south. And they can be some of the most debilitating issues as well – anyone who’s ever had a sore tooth will know how painful that is.
“Waiting nine months until you come home to get it fixed really isn’t an option.”
The AAD gives doctors two weeks of dental training before they head south. This means they have enough knowledge to temporarily manage any dental problems – but only with dentists dialled in to provide telemedicine too. The same goes for other specialties.
For long-haul spaceflight, this model would have to be adjusted slightly: messages from Mars, for instance, could take between five and 20 minutes to get back to Earth.
So there are specialists on the phone, but what if you need an extra pair of hands on the job? The AAD has a solution for this too: other expeditioners who are trained to assist the doctor, called “lay surgical assistants”.
“During my winter, my lay surgical team consisted of a carpenter, a boiler maker, a chef and an electronics engineer,” says Cherry.
“They don’t take the role of the doctor, but they’re there to support the doctor in cases of medical emergency.”
“That, again, is a model that could work really well for long duration spaceflight.”
According to Cherry, Australia’s experience with rural doctors makes us a good nation for providing medicine in Antarctica – and our Antarctic experience will suit us well in space.
“Our medical capabilities within the within the Antarctic setting are really unparalleled with any other Antarctic nation,” he says.
“I think that, as a nation, is where we are uniquely situated to contribute to long duration spaceflight – by providing doctors with those skills to the international community.”