From Botswana to Bolzano, meet Eurac Research’s Flying Dutchman

Talking wilderness medicine, the new normal post-Covid and the future of drones in mountain rescue operations, Dr Michiel van Veelen’s journey to the Institute of Emergency Mountain Medicine has been a little circuitous, but he wouldn’t have it any other way.

You come from Holland, last time I heard there weren’t so many mountains there, how did you end up in Bolzano, working for Eurac Research’s Institute for Emergency Mountain Medicine?

Michiel van Veelen: My background is that I’m an emergency physician. I trained in the Netherlands and ever since training in emergency medicine I’ve been drawn to Expedition and Wilderness Medicine – basically, the skill set you need as a doctor to diagnose, treat and manage medical emergencies in remote settings with limited resources. Mountain medicine is part of that. During my training, I founded Outdoor Medicine; the Dutch society for teaching wilderness medicine. Knowing the field, and which institutes were producing research, meant that I was aware of Eurac Research’s output. After my training I moved to Botswana and worked there for the university, and for the medical air retrieval service for three years. I was part of a team ready to respond by helicopter, or more often small fixed wing plane to medical emergencies in remote places. It was at that time I saw there was a position at the Institute for Emergency Mountain Medicine. I thought it would be an interesting next step to gain research skills working in a field I love.

The most frightening weeks of Covid-19’s impact seem to be behind us –would you say we’re out of the water?

MvV: It’s really difficult to say – the most likely scenario is that Covid-19 will remain with us, albeit with low numbers. Social distancing will probably have to continue until there is a vaccine, and if positive cases are found, contact tracing will be implemented, which will affect social life and work in the hospital. We’ll need to prevent contact with the confirmed and unconfirmed cases -it will persist in being quite complicated logistically. Having said that, the main Covid-19 ward where I was working in Bolzano has closed. It was the medium care unit, basically, the step-up unit before or step-down unit after  intensive care admission for more accurate monitoring of patients than a normal nursing ward. Although, the large numbers have receded, there’s still a few Covid-19 patients in different units, like the infectious disease unit for example.

image: Pilatus-pc 12 Botswana Okavango air rescue, courtesy of Michiel van Veelen

From Botswana and Bolzano, how have your past experiences correlated to your current situation?

MvV: Although there were no cases of Ebola during my stay in Botswana, I did practice Ebola management and wearing personal protective equipment whilst there. During the first peak of the current Covid-19 pandemic I also worked in the Emergency Department in a hospital in the Netherlands for a couple of weeks, there I gained me a lot of insight to how people with Covid-19 presented their symptoms, what their disease progression was and what sort of management they required. Working in different settings with different protocols and cultures has taught me to be flexible and adaptable in my work as a doctor.

Two hospitals, two countries, how did that happen?

MvV: During the past few months I was going back and forth between the Netherlands and Italy, I work as an emergency physician a week a month there in the Emergency Department so was travelling up and down by car during Covid-19. I also volunteered at Bolzano’s hospital, it was because of my previous experience and role at the Institute for Emergency Mountain Medicine that I was fortunately able to circumnavigate some of the bureaucracy involving language. It was also really important that Eurac Research was able to cooperate with the local health services – it was an exceptional situation . It was quite challenging though, the main language in the hospital in Bolzano is Italian, it’s used for the handover meetings as well as patient documentation. My German is fine, and I have a reasonable understanding of Italian – especially because medical terms are very similar in most languages, so with the help of colleagues it was possible to work. Although speaking Italian was a bit of a challenge though, in some cases I also had to assist the Italian doctors talking to German speaking patients or family members.

image: Eurac Research / Tiberio Sorvillo

Lots of challenges, what was the most difficult?

MvV: Plenty of difficult conversations with very sick patients and their family members about poor prognoses and limited treatment options. Personal contact was made even more difficult by having to wear the extensive personal protective equipment too. In the first phase of the pandemic, the anxiety of what would happen if the hospitals would reach capacity was also a challenge – it actually came close to happening, especially concerning ICU bed capacity. The ICU capacity in the Netherlands nearly doubled and even then, still had to fall back on transferring patients to Germany at the peak of contagion, just like South Tyrol.

Now that you have a bit more time, what are you focusing your research on?

MvV: I’m now involved in a study which pilots innovative technologies in mountain rescue. We plan to study the effects of using drones in mountain rescue missions as we believe there could be extensive health benefits in achieving time saving in the localisation of victims as well as the early use and application of medical equipment (such as Automated External Defibrillators (AED’s) transported by drones. An experimental study will be performed in the Bletterbach Geoparc this fall, it’s a Unesco heritage site characterised by a deep gorge, the limited cellular and GPS reception there is one of the greatest challenges for mountain rescue teams, so it’s an ideal place to begin.

Michiel van Veelen is currently working as a researcher at the Eurac Research Institute of Emergency Mountain Medicine where he is investigating medical possibilities and applications of drones, about once a month he commutes from Bolzano to the Netherlands where he is employed as a medical doctor in the Emergency Department. He previously worked as a HEMS & Aeromedical Retrieval Physician for Okavango Air Rescuein Maun, Botswana where he was also a lecturer in Emergency Medicine in Gaborone, Botswana..

Rachel Wolffe is a recent addition to the communications team at the Eurac Research, hailing from Zimbabwe, she grew up in England and studied Egyptology at Liverpool University and now lives in Bolzano. She talks a lot, so this is a great job for her.