Visionaries: Scott Parazynski practices extreme healthcare in Antarctica

Scott Parazynski in space gear

Meet the South Pole’s top doc. TEDMED 2010 speaker, Scott Parazynski, is the new medical officer and director of the Center for Polar Medical Operations at the University of Texas Medical Branch (UTMB), where he’ll oversee medical screening and on-ice care of all personnel in the National Science Foundation’s United States Antarctic Program.

Parazynski is also a former NASA astraunaut who flew on five shuttle missions and conducted seven spacewalks, a mountaineer who scaled Everest, a pilot, a competitive luge racer and Olympic luge coach.

Q When will you be leaving for Antarctica? How are you preparing yourself and the staff, medically?

SP I’ll be heading down around Halloween and will spend about a month on the ice at McMurdo [Station]. It’s my first time on the ice. In the spring, I’ll go to the other side of the ice, to the Palmer Station. It’s a strange marriage here in Texas, operating all the medical activities in Antarctica from the most sweltering spot in America.

Winter storm in McMurdo. Photo: NSF

Right now we’re sending hundreds of people down to Antarctica, so it’s the busiest time for us. I used to have a career in the space program, and of course we were scrutinized in incredible detail when we were selected, because it costs a lot to train an astronaut for those incredibly expensive missions. They knew everything about us. It’s quite similar in the Antarctic environment, but we can’t afford to do the same level of medical screening. I also suspect that in general the Antarctic personnel are not as physically fit nor quite as young as the astronaut corps. But we do have medical facilities at all three major stations in Antarctica, so we try and get as many folks on the ice as we can safely.

Q What are the working conditions like?

SP We have the wherewithal to handle the likely medical scenarios. We don’t have CT or MRI scanners, or an operating room and ICU, but we have functional urgent care centers so we can take care of problems for a short time. Occasionally, you have to lift someone off, though it’s a very difficult task in the wintertime to actually get someone off the ice. It’s a very risky rescue operation.

I’ve done a lot of things in remote environments, such as the Himalayas, and I always ask the people I recruit, ‘Have you had to MacGyver medical solutions in your clinical practice? We don’t have the range of equipment and medication that you have in your hospital. Are you capable of thinking on your feet and coming up with real-time solutions?’”

However, UTMB is a world leader in telemedicine, so we can guide people through real-time procedures from our base in Galveston. Healthcare delivery in Antarctica is kind of like medicine on Mars. You have a very austere environment.

What are some of the conditions you’re most likely to see?

Standard working gear at McMurdo. Photo: NSF

SP Slips, trips, falls, sore throats and runny noses are the basics. But it’s a unique environment with a higher incidence of orthopedic issues. It certainly does set you up for frostbite, but you get good protection with the heavy uniform. It’s like walking around inside of a marshmallow suit. Snow blindness is a problem. The South Pole station is 11,000 feet above sea level, and people fly there from McMurdo, so you have altitude sickness. We also run dive operations, so there’s the potential for dive injury.

Q Can you talk about ongoing medical research in Antarctica that may have implications for future treatments or interventions?

SP I have to reflect back on my days in NASA as well to answer this. The kind of technologies and solutions that we develop for these extreme environments have great value for general healthcare. For example, the advances in telemedicine that we’re working on for Antarctica may have great potential for family care practice in rural America or remote Africa.

Also, we aim for miniaturization and specificity of medical tools, such as handheld devices for the medical clinics. These will one day be the medical devices for your doc-in-the-box. They’re very expensive at the outset, but with economies of scale they’ll be useful in the general public one day, off the ice.

Another unique element of Antarctica is the isolation component. We send people to these austere environments where it’s dark 24/7 for months at a time, and you’re seeing people day in and day out with no hopes of leaving. So there are longitudinal investigative studies useful for studying seasonal affective disorder.

Q You’ve lived and worked in Africa and the Middle East. Have you taken away healthcare lessons from other cultures that impressed you? Any that might help the U.S. in our current situation?

SP I was going to do a long-duration space flight aboard Mir and I went to Star City, Russia to do my training. I had to go through a bunch of doctors poking and prodding me to see if I was ready for their training program. I’m a pretty fit guy, and I thought it would be a slam dunk.

But a few years prior, I had had a minor ski accident skiing in a whiteout. I hit my shoulder on a snow bank and had to nurse it for several months. In one medical examination, the Russian surgeon noticed a very subtle difference in my [pectoral muscles]. I couldn’t even tell by looking in the mirror, but he knew that I had asymmetry in my muscle group.

We’ve become too focused on technology in America, and there is still an art to medicine that many people in the world practice, certainly in these remote environments and in rural America. Perhaps now with the financial pressures upon us with healthcare reform, we’re going to need to get back to that and look for subtle findings, make better clinical judgments, hone our skills, and MacGyver solutions using the equipment available.

Q You’ve been an astronaut; you’re a diver and a mountaineer. It seems that many of your career choices are driven by the desire to explore limits and to tap the unknown. Is this a conscious choice?

SP Life is an adventure, and the people that inspired me the most when I was growing up were all scientists, engineers and creative, inventive people. But they also had skin in the game. They were also out there doing things, participating in discovery. I like to build new things in challenging new environments. I’m not much of a steady state person.

Q Are you taking anything special with you to the Pole? Any special plans to mark the visit?

SP Yes, you do want to bring some bling with you to these places. For this, I’ve been training myself to do a good handstand. I really want to get the bottom of the world and do a  handstand, and have an Atlas photo.

Q Have you had to conquer fear, and if so, what’s the one thing you always tell yourself?

SP I have been fearful at times that I wouldn’t succeed. I had this spacewalk on my last mission [STS-120 Discovery], and it was very high stakes, and if I hadn’t succeeded there would be huge repercussions for the program, and it was up to me to finish the job.

Scott Parazynski, the first astronaut to summit Mt. Everest

Also, there was summit morning on Everest. The experience is weird — you leave your tent in the middle of the night. And you do think, ‘What’s this day going to be like?’ There are doubts: ‘Am I going to summit? Am I going to make a round trip out of this?’ I’m hoping I’m worthy and strong enough and that I’m going to make the right decision. I had various doubts along the way, but I just focused on the fundamentals: Buckle in carefully, listen to your body and stay hydrated.

Q Countless kids all across the U.S. want to grow up to be just like you. Who were your idols as a kid? Who are they now?

SP For me it was John Glenn, Yuri Gagarin, [Edmund] Hillary, [George] Mallory and [Andrew] Irvine, Lewis and Clark, Jacques Cousteau — folks who were explorers, scientists and who really had skin in the game. Sir Roger Bannister really amazed me, and he was a physician as well. He broke the mile down and said, ‘I need to run at this pace, at this or that piece.’

I still think space is the place. I hope kids still want to grow up and become astronauts. It’s a different environment now. I grew up in the shadows of Apollo, and now kids have computer games with space planes and all kinds of wild stuff. Can they suspend belief and go out and actually do these kinds of things? I’m the chairman of the board of the Challenger Center for Space Science Education. We hope to inspire kids to go out and explore.

I really admire the commercial space flight industry. These are folks that are so passionate that they’re willing to spend their own time and energy to make this happen.

Also, Jim Cameron’s descent in Challenger Deep was an amazing technological feat. Only a couple of guys have been down there, and the last time was decades ago. It was really an audacious accomplishment.

–Interviewed by Stacy Lu

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For more about practicing medicine in extreme environments, watch Scott Parazynski’s TEDMED speech.

This interview has been edited for space and content.

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