3. At the bottom of the dancing aurora

White nights end around mid-January. Towards the end of February, nights begin to become darker still, and during nice weather, the aurora dazzles onlookers in against a sky full of stars. The length of the day decreases by 5 hours per month up to the polar night. The speed of change is fast enough for observers to notice the difference in brightness within 2 days. The weather deteriorates and the temperature drops rapidly.

At the outpost, work progresses smoothly. The medical office has adequate space in the narrow station. One of the two station doctors is a surgeon. Most stations in Antarctica have only one doctor, which is risky, as he or she may also require medical attention. To avoid this hazard, stations such as JARE make the presence of two doctors mandatory. There are no other medical staff such as nurses.

The total number of injuries and diseases during JARE's first 43 wintering-over periods is 4931 cases (from 1956 to 2002) [2]. The percentage of occurrences sorted by specialty is shown in Figure 5 above. The most common cases comprise injuries, followed by internal medicine issues and dental problems, respectively. Dental problems are known to be prevalent at every Antarctic station. Because all kinds of medical troubles including dental problems occur among Antarctic overwintering participants, doctors universally act as generalists.

#### Figure 5.

icebreaking capacity has progressed significantly since Japan began sending Antarctic expeditions, and Japan has been forced to abandon overwintering of the second expedition team in 1957 and to reduce the number of wintering-over members for the 55th and-56th expedition in 2013—2014 when only one doctor was available. The second factor affecting wintering team member size is the capacity of the station. The station is expanded every year, and it is scalable to accommodate more than 40 wintering members. The third is the size of the research plan. Due to observation automation and the use of aircraft in the summer, the number of summer parties expanding their activities has increased and the number of wintering members is decreasing. Japan's first team consisted in 11 members; the number increased, peaking with 44 members in 2003. More recently, wintering parties have

Trends in number of crew members and their average ages. The first team was composed of 11 members. The number has increased to peak at 44 and then decreased to around 30. The average age has increased gradually.

The wintering-over member's average age has been trending upward year and

Women have been participating in Japanese Antarctic wintering-over team since

The composition of the wintering-over party is decided a year prior to departure. Candidates are subjected to a rigorous health check including head CT, gastroscopy, abdominal ultrasonic examination, and electroencephalogram. The examination also includes a psychological assessment. Researchers and some logistics staff are selected by recommendation. Other staff members, such as medical

Each new group meets when they begin to prepare for the trip. The selected candidates participate in two training camps in winter and summer. After completing the camp trainings, they start gathering supplies at the expedition centre 5 months before departure. They also complete a 24-hour shared life experience on the outbound ship. Through this training, mutual understanding and relationships gradually develop. In such isolated conditions as those in Antarctica, cooperation within the team is indispensable not only for research but also for the safety of the station and wintering-over members. Despite their extensive training, some members might have difficulty adapting to their new environment. Cases of severe depression and suicide have been reported at other international stations. Methods for screening for unsuitability at the time of selection have been studied, though

year. In 2015, the average age of wintering team was 37 years old.

1998. They totalled 5% of participants from 2002 to 2015.

doctors and cooks, are recruited through public offering.

comprised about 30 people.

The most recent team's average age is 37 years.

Antarctica - A Key to Global Change

Figure 4.

106

Medical consultations of wintering crew members. The total number of medical consultations at Syowa Station cases from 1956 to 2003 was 4931. Among them, 4633 cases with known onset month were analysed. The most common cases were surgery and orthopaedics, followed by internal medicine and dental problems, respectively. The diseases covered every field.

The sole death at Syowa Station was caused by distress in a blizzard. The majority of the recorded 76 deaths at Antarctic stations were caused by accidents (e.g., aircraft accidents, falls, distress, and carbon monoxide poisoning). However, acute cardiac insufficiency, such as a myocardial infarction, has also claimed wintering-over persons [3, 4].

The medical post in Syowa Station is equipped much like a small hospital in Japan: it has the capacity to conduct X-ray fluoroscopy, electrocardiograms, blood tests, and abdominal ultrasounds in addition to general examinations [3, 4]. Although the equipment is rarely used, it is always maintained as well as in Japan so as to handle any emergency; the station is prepared to treat severe cases, all anticipated diseases expected to occur, and even rare but serious infectious diseases such as tuberculosis.

Syowa Station has an operating room with enough equipment to conduct surgical operations under general anaesthesia. To date, two appendectomies have been conducted at the station. Other stations have reported operations relating to appendicitis, subdural hematoma, and fractures. Surgical operations are extremely difficult to perform in Antarctic conditions for a variety of reasons, such as difficulty maintaining anaesthesia, applying blood transfusion via "walking blood bank", preparing an aseptic operation space and working without assistants such as nurses. In a case at a Russian station in 1961 illustrating the risks of relying on a single physician, the station's sole doctor was forced to perform surgery on himself when he suffered from appendicitis [5].

other fields. However, in certain areas as audiology and dermatology, the technology shows some limitations because of the difficulty in taking images or ensuring a high enough resolution [6]. In summary, consultations with colleagues in Japan have advantages for both patients and Antarctic doctors who deal with patients issues outside their own specialty and within the restrictions of the limited local

Telemedicine Scene. The patient has a knee ligament injury. To evaluate the joint motion and pain, the therapist in Japan (left side in foreground) demonstrates the procedure on the simulated patient (right side). Then, Antarctic doctors (on the screen) perform as instructed by the therapist in Japan, who diagnoses the case

An Antarctic doctor lives with several constant stresses, including the tension between the knowledge that their services may not be required—healthy young participants rarely need doctors' aid—but , once they are needed, that need may be extraordinary, and they may not be able to save the lives of those suffering from

It is the first experience for almost all doctors to visit Antarctica. They are confused by the difference of medicine between Antarctic environment and the daily site. However, if it is possible to predict the diseases which may occur and the time of onset, doctors can prepare themselves and take preventive measures.

For that purpose, an analysis was done on the medical consultations of participants at Syowa Station during the first to 43rd wintering over (from 1956 to 2003). The total number of wintering-over participants was 1278; 4931 medical cases occurred during this period. Among them, 4633 cases in which the month of onset

In the analysis of each year, there are limitations in seeing the original tendency because the number of cases is small, and circumstances unique to each year may

Figure 7 shows numbers of monthly consultations. The cases increase at the start

of overwintering and sharply drop during the polar night. Thereafter, the rate shows a gradual decreasing trend with no particularly notable changes.

Frostbite increases and peaks in May (Figure 8). This coincides with late autumn which is not the coldest season of Antarctica, experiencing temperatures of 15 to 20°C (rarely experienced in Japan) that drop rapidly. Such an increase in

4. Careless frostbite and unpreventable frostbite

was clear were used to analyse rates of incidence by month.

exert influence. Aggregation over 40 years eliminates these problems.

frostbite incidence may be due to carelessness and unpreparedness.

facilities.

Figure 6.

and recommends a therapy plan.

Human Beings in Antarctica

DOI: http://dx.doi.org/10.5772/intechopen.81974

severe issues.

109

Given capacity limitations, there are cases when evacuation to Japan becomes necessary. At Syowa Station, four medical evacuations have been undertaken for patients who suffered pelvic and femoral fractures, acute renal failure, and arrhythmia. Three cases required sea evacuations that lasted 25 to 120 days. The other case was air lifted to Japan. This patient was carried by a small regional plane to Norway's Antarctic station 1200 km away, and this is one of the few stations equipped with a runway that an intercontinental airplane can use. The patient was then transported to Japan via South Africa over a period of 6 days. Although the use of an aircraft drastically shortened the evacuation duration, it cannot be said that the procedure is fast enough to suffice in case of a severe emergency. It was fortunate that all evacuations happened in summer, when it was still possible to transport patients off the continent [3, 4].

Every country operating in the Antarctic, including Japan, pursues the possibility of an evacuation route, especially in winter. Though a few intercontinental air operations have been conducted in winter as unusual events at certain stations under extremely favorable conditions, it is nearly impossible for any evacuation or rescue team to operate either by sea or air during winter because of limited visibility and bad weather.

Medical collaboration occurs between various nations in areas where stations are adjacent. There are nine stations of representing eight countries on King George Island at the northern tip of the Antarctic Peninsula. In these areas, mutual medical cooperation is advancing through consultation on specialised fields, shared use of inspection equipment, and so on. However, most of the stations on the continent, including Syowa Station, are isolated and do not have any nearby stations with which to cooperate.

In such situations, telemedicine plays a vital role; it has been successfully operationalised in Antarctica. Nonetheless, it is notably restricted by the technology available. In 2004, a satellite television connection was installed, linking Syowa Station and domestic hospitals in Japan (Figure 6). Telemedicine using this system is highly effective for both diagnosis and treatment in orthopaedic medicine (e.g., fractures, arthritis, and ligament injuries), rehabilitation, and dentistry, among

#### Figure 6.

The sole death at Syowa Station was caused by distress in a blizzard. The majority of the recorded 76 deaths at Antarctic stations were caused by accidents (e.g., aircraft accidents, falls, distress, and carbon monoxide poisoning). However, acute cardiac insufficiency, such as a myocardial infarction, has also claimed

The medical post in Syowa Station is equipped much like a small hospital in Japan: it has the capacity to conduct X-ray fluoroscopy, electrocardiograms, blood tests, and abdominal ultrasounds in addition to general examinations [3, 4].

Although the equipment is rarely used, it is always maintained as well as in Japan so as to handle any emergency; the station is prepared to treat severe cases, all anticipated diseases expected to occur, and even rare but serious infectious diseases such

Syowa Station has an operating room with enough equipment to conduct surgical operations under general anaesthesia. To date, two appendectomies have been conducted at the station. Other stations have reported operations relating to appendicitis, subdural hematoma, and fractures. Surgical operations are extremely difficult to perform in Antarctic conditions for a variety of reasons, such as difficulty maintaining anaesthesia, applying blood transfusion via "walking blood bank", preparing an aseptic operation space and working without assistants such as nurses. In a case at a Russian station in 1961 illustrating the risks of relying on a single physician, the station's sole doctor was forced to perform surgery on himself when

Given capacity limitations, there are cases when evacuation to Japan becomes necessary. At Syowa Station, four medical evacuations have been undertaken for patients who suffered pelvic and femoral fractures, acute renal failure, and arrhythmia. Three cases required sea evacuations that lasted 25 to 120 days. The other case was air lifted to Japan. This patient was carried by a small regional plane to Norway's Antarctic station 1200 km away, and this is one of the few stations equipped with a runway that an intercontinental airplane can use. The patient was then transported to Japan via South Africa over a period of 6 days. Although the use of an aircraft drastically shortened the evacuation duration, it cannot be said that the procedure is fast enough to suffice in case of a severe emergency. It was fortunate that all evacuations happened in summer, when it was still possible to

Every country operating in the Antarctic, including Japan, pursues the possibility of an evacuation route, especially in winter. Though a few intercontinental air operations have been conducted in winter as unusual events at certain stations under extremely favorable conditions, it is nearly impossible for any evacuation or rescue team to operate either by sea or air during winter because of limited visibility

Medical collaboration occurs between various nations in areas where stations are adjacent. There are nine stations of representing eight countries on King George Island at the northern tip of the Antarctic Peninsula. In these areas, mutual medical cooperation is advancing through consultation on specialised fields, shared use of inspection equipment, and so on. However, most of the stations on the continent, including Syowa Station, are isolated and do not have any nearby stations with

In such situations, telemedicine plays a vital role; it has been successfully operationalised in Antarctica. Nonetheless, it is notably restricted by the technology available. In 2004, a satellite television connection was installed, linking Syowa Station and domestic hospitals in Japan (Figure 6). Telemedicine using this system is highly effective for both diagnosis and treatment in orthopaedic medicine (e.g., fractures, arthritis, and ligament injuries), rehabilitation, and dentistry, among

wintering-over persons [3, 4].

Antarctica - A Key to Global Change

he suffered from appendicitis [5].

transport patients off the continent [3, 4].

and bad weather.

which to cooperate.

108

as tuberculosis.

Telemedicine Scene. The patient has a knee ligament injury. To evaluate the joint motion and pain, the therapist in Japan (left side in foreground) demonstrates the procedure on the simulated patient (right side). Then, Antarctic doctors (on the screen) perform as instructed by the therapist in Japan, who diagnoses the case and recommends a therapy plan.

other fields. However, in certain areas as audiology and dermatology, the technology shows some limitations because of the difficulty in taking images or ensuring a high enough resolution [6]. In summary, consultations with colleagues in Japan have advantages for both patients and Antarctic doctors who deal with patients issues outside their own specialty and within the restrictions of the limited local facilities.

An Antarctic doctor lives with several constant stresses, including the tension between the knowledge that their services may not be required—healthy young participants rarely need doctors' aid—but , once they are needed, that need may be extraordinary, and they may not be able to save the lives of those suffering from severe issues.
