Prof. Krishnan Ganapathy
Distinguished Professor at Tamilnadu Dr MGR Medical University, India & a WHO Digital Health Expert. Past President of the Telemedicine Society of India, Neurological Society of India, and Indian Society for Stereotactic & Functional Neurosurgery. Member of the Board of Directors of Apollo Telemedicine Networking Foundation and Apollo Telehealth Services, and InnovaSpace Advisory Board member - Visit: drkganapathy.com
Distance is Meaningless and Geography has become History - paraphrasing Star Trek's Captain Kirk, played by William Shatner (who just flew on a sub-orbital flight on 12th October 2021 at the age of 90 years) and going where No man has ever gone before is not the prerogative of the elite 600 plus astronauts who have left the confines of Terra Firma. In an activity that would have seemed like science fiction just a few years ago, 30 Retinal Specialists have been peering into 2800 eyes a day from a distance of 175 to 350 km, and ensuring that a digitally-signed colour-coded annotated fundus report (assisted with semi-automated diagnosis) is physically provided to each villager within 25 minutes. And this has now been happening daily for the last 43 months, in a service that the beneficiary gets totally free, thanks to a Public-Private Partnership project.
An acute shortage of eye care personnel in rural India results in millions unnecessarily developing visual impairment. Early diagnosis and initiation of corrective measures remotely could be a major public health initiative, whereby the Government fills a large void by providing free, quality eye care services, including spectacles, to the community.
The Andhra Pradesh Government has now been implementing the “Mukhyamantri e-Eye Kendram-MeEK (http://enethraap.phc.ind.in/) program since 1st February 2018. This tele-ophthalmology service is one of the largest Public-Private Partnership projects. In just 43 months 1.7 million patients have had their eyes checked in 115 Eye centres located in 9 districts of Andhra Pradesh, a state in southern India. A total of 1.4 million spectacles have been ordered following 1.7 million refraction checks!
The operational challenges in providing “customer delight” to 2000 + people every day in so many rural centres is indeed a humongous task. Some 0.5 million fundus examinations have been performed remotely and abnormal pathology detected in 83,000 cases, including Diabetic Retinopathy, Hypertensive Retinopathy, Glaucoma and other pathologies.
Continuous quality control and ensuring constant compliance and adherence to strict deliverables is in the DNA of the entire fantabulous team who continued to work even during the height of the pandemic.
Obsession with perfection - where failure is not an option, making the impossible possible - these are the stuff of which astronauts and the entire extended team remotely connected with space exploration are made up of. Who knows, perhaps this project is a good recruiting ground for ISRO, ESA and NASA – after all there are a lot of similarities !!
Final blog from ESA-sponsored Dr Stijn Thoolen, from his series written while spending 12 months at the Concordia research station in Antarctica. Catch up on the rest of his fascinating blogs by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11, Part 12
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
L’Astrolabe icebreaker, December 15, 2020
Sunlight: 24 hours a day, but tomorrow, as we head further north, it will set again
Temperature: Around 0 °C
Mood: not sure how to describe it today. I am excited and just feel very lucky.
It’s midnight. Since our departure some hours ago the sun has steadily moved towards the horizon behind us, and it has started to paint the sky in colours that make me think of winter again. Huge icebergs are slowly passing by, and every once in a while there is a bunch of curious penguins waving us goodbye from their ice floe. Not much earlier I saw a seal chilling, and there have been whales too. In the very far distance I can still recognise the enormous ice mass on which we have been living our lives the past year. It’s my last view of the Antarctic, and it’s perfect.
Standing here alone on the deck of the Astrolabe surrounded by all this beauty I have found myself a special opportunity to appreciate once more where the #$%!! (beep) we have been all this time. It is just so different there on top of the ice, so far away from the rest of the world, that as we are slowly being re-introduced to civilisation I am having a hard time believing it actually happened. With all the changes that we have gone through lately and with all the new impressions time has gone fast, and it has made Concordia feel like a distant, almost unrealistic memory. Like ages ago, even though it has only been eight days since we left…
It started when the ‘orange and fat’ people (and kiwis!) arrived at Concordia about a month ago. With the start of the summer campaign our winterover isolation had come to an abrupt end, and I remember the calm, safe and familiar environment of the ESA lab feeling surprisingly pleasant after some intense hours of new social interactions. As a positive summer energy took hold of the station and fresh ESA MD Nick gradually took over the lab, there was no way for me to hide anymore. Unavoidable steps out of our rigid routines, but at that ‘c’est l’Antarctique’ rate of change that isn’t always easy to keep up with.
Our departure from Concordia last week was much the same. Emotionally numb from a lack of realisation of what was happening (or a lack of sleep the night before…) it just passed by so quickly, and surprisingly smooth. I said my goodbyes without any affection for the tears around me. I gave the station a good last look for the sake of memory. But when the plane started accelerating for lift-off, suddenly that strong desire came up to make it stop and bring me back safely into the station. Apparently part of me wasn’t ready to leave at all. Too big steps too quickly I guess, but lucky for me there were pilots taking care of that...
Then, in the plane already, as we approached the coast, we could feel the air getting denser, and breathing becoming easier. There were thick clouds, the sort of which I hadn’t seen in a year, and in front of us there was so much water. Actual liquid sea water! At Dumont d’Urville we caught up on hours of lost sleep, running did not cost any effort (our bodies’ oxygen transport system had become quite efficient after a year at altitude), and even penguin-watching was a comfort after the complex social dynamics of Concordia. Everything seemed easier here, and it gave us an extraordinary opportunity to process our adaptation to life on ‘Earth’, before continuing our journey homewards.
But it is only now, here on the deck of the Astrolabe in this beautiful, perhaps spiritual moment, that I have taken the time to say goodbye. After all these impressions over the past weeks and finally having finished my last work (yesterday I performed my last round of measurements with the crew, to see how we physically adapt to the sea level environment again), I now realize my great Antarctic adventure is over. Happy with the results of my efforts over the past year, I feel relieved, proud, and incredibly lucky. And as I slowly leave the continent behind me, I also feel more and more ready to look ahead again. The empty (and perhaps COVID-infected) horizon here at sea makes me curious. What will I find there, back home? How will I adapt? What do I bring back from Concordia, and what effect does that have on me and the people at home? Some have warned me the world isn’t the same anymore after all what happened the past year. Others made me rather excited about the increased awareness that I may experience being a true revelation. I guess it will always remain hard to foresee what the future brings, but I find my comfort in the idea that it must be as much an adventure as coming here in the first place!
All the above also means I am writing my last blog entry here. Hopefully you have enjoyed my efforts to share some of my adventure with you. It has been a huge privilege living and working in Concordia. A beautiful and very interesting year that I (already) look back at with much gratitude and satisfaction, and that I imagine to stay with me for a looong looong time. A big thanks to everyone who made this possible and who has supported me along the way, all the very best for Nick and his crew in Concordia the coming year, and as we liked to say up there on the ice: allez-ciaooo!
Signing out from the Astrolabe,
A penultimate blog from ESA-sponsored Dr Stijn Thoolen, from his series written while spending 12 months at the Concordia research station in Antarctica. Enjoy the rest of his fascinating blog series by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10, Part 11
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
Concordia, November 29, 2020
Sunlight: 24 hours
Windchill temperature: -45 °C
Mood: positive, focused
Today is Sunday. We are on full summer campaign steam for two weeks now. There are about 40 people occupying the station, but today nobody works. Instead, I am wearing three layers on my legs, five on my torso, two pairs of socks, neck warmer, two balaclavas, hat, goggles, glove liners, mittens, radio, and of course my running shoes. I prepared two-and-a-half litres of isotone sport drink and extra electrolyte tablets against the dry desert atmosphere. Extra goggles for when my visor fogs from sweat that cools off in the freeze. Battery-powered heated gloves, air-activated hand- and feet warmers as well as another pair of shoes for when my body becomes unable to pump sufficient blood to my fingers and toes to keep them warm. Bananas and chocolate bars accommodating high energy demands at this altitude and these temperatures. Spare radio battery to make sure I maintain contact with the station. Tape for whatever unforeseen circumstances, and four volunteers and a skidoo standing by to support me with whatever I request.
Today I am going to run a marathon.
I guess I can sometimes be a bit of a dreamer. Not necessarily in the sense that I tend to lose touch with the world around me in order to float around in some self-invented realm in a galaxy far, far away (no worries, I do that too sometimes), but I do like to fantasise about doing things that are commonly perceived as unachievable. Or at least to say a challenge. Then afterwards I see myself devoting quite some time towards realising (some of) such ideas, because it makes me feel good. Contradicting, right? Well, I have to admit I sometimes do find myself wondering why the … I got myself in an awkward position again, but overcoming a challenge in the end always makes me feel proud, and most importantly the experience that comes with it makes me learn.
As I have probably mentioned in all my previous blogs (hope I am not starting to bore you), I strongly believe that pushing yourself into an unknown (decide for yourself how) and leaving your comfortable space can broaden your horizon. We can allow ourselves to understand the world around us from new perspectives, and see new ways of tackling the difficulties that life will offer us. In that sense, I guess it can make us more resilient. Isn’t that exciting?
It is this curiosity that made me come to Antarctica in the first place, and enjoy the winterover experience that is often said to bring positive psychological impact to those who are able to overcome the challenge of being far from home in isolation and confinement. It is also why I like the bold endeavour of human spaceflight, where we are pushing our scientific and technological limits to get a better view on ourselves. Actually it is why I like science in general. Based on our ideas we make careful steps into the unknown, and then evaluate those steps to learn about the problems that we and our earth face today so that we can try to overcome them. In comparison to all this my undertaking today looks rather pale, but I figured it fits nicely into the theme. A small struggle, but for an enormous reward…
Ever since I have arrived in Antarctica the marathon has been on my list. Preparing for it has been a beautiful way to explore my physical and mental limits, and getting in touch with this strange environment here.
But it has obviously taken some effort to get to the point that I feel capable and confident enough to give this long-distance run a try. You can imagine that the low oxygen levels have required time for my body to transform into a more efficient fuel burner, and I have done plenty of runs outside the previous summer to understand how to dress up to prevent myself from freezing. Previous running experiences such as in humid India and the dry Moroccan Sahara have given me an idea of how to build up my training schedule and manage my fluid intake, and after all those years and kilometres I like to think I gained a reasonable sense of what physical fitness and running pace I need to maintain to prevent hitting the well-known ‘wall’. After all, a challenge can quickly become a danger if it is beyond our capabilities!
So today, after one year Concordia, some 70 running sessions, 200 kilometres in the snow and 850 kilometres on the treadmill I feel ready for it. An exciting long-term effort, that illustrates perhaps how I like to think of Concordia. Like spaceflight, it’s a place for bold endeavours and long-term science, to increase our resilience as a person, as a species, and as a planet, for a better future.
What do you dream about?
Biomedical engineer, with a focus on emerging technologies and their role in the changing world of healthcare. He explores how they will impact the care delivered to patients, but is also equally interested in how they could benefit the future of long-term spaceflight. He believes both questions are opportunities for collaboration and inspiration!
How would you deal with physical and mental health needs on a three-year round-trip to Mars? Those are questions I often think about and I would like to take you on a tour of solutions already out here on Earth, that might benefit those first astronauts to the Red Planet.
Last week SpaceX performed another successful test of its Starship. The Starship is designed to eventually bring as many as a 100 people to Mars per flight.
We’ve seen many recent plans for human spaceflight, both commercial and non-commercial and it’s about right to say that humankind will go on more and longer duration space missions. A lot of engineering research is going into the development of rockets and other technological advancement, but just as important as getting there, will be getting there alive and healthy!
That’s not a trivial problem: Especially when we will go on deep space missions to Mars and beyond we will run into some basic limitations. There will be communication delays, we will have limited medical equipment on board due to limitations in mass, volume and electricity, and limited medical skills. A doctor can come along, but the doctor can also become sick, and of course, emergency evacuation to Earth will no longer be an option.
Therefore, we will need a sense of medical autonomy for those astronauts on the go. We will send the most healthy human beings on such a mission, but a 3-year trip is a long time to stay healthy in the extreme environment of outer space. If not physical problems, then also psychological issues can become a risk to the success of the mission, which the crew themselves will need to deal with. In this quest for medical autonomy, I argue, we can learn from trends in healthcare and healthcare innovation on Earth, so let’s shortly take a trip back to Earth.
In this short overview of the history of healthcare, a lot has happened since Hippocrates worked out the oath for medical professionals. None of the developments shown however, were as fundamental as the last one, the advent of digital health technologies. By becoming digital, solutions for healthcare have become smaller, faster, cheaper and in many cases, smarter. Solutions are leveraging Artificial Intelligence, Virtual and Augmented Reality, blockchain, voice recognition and 3D printing. These are just some of the technologies that are impacting healthcare.
As a result of this impact, we see various shifts in healthcare, going from a reactive system to more preventive care and from a one-size-fits-all-healthcare to precision medicine. Most importantly, however, you see a shift in power. The relationship between the doctor and his or her patient is changing from a more dependent relationship, into a partnership, in which the patient is empowered with technology, to take care of his/her own health or medical issues.
In other words, terrestrial patients are becoming more autonomous when it comes down to their health and care. It is this change, that is also needed for astronauts on their way to Mars. A different relationship between astronauts and their doctors in mission control is needed and this can be achieved, by leveraging new health technologies.
Here are 3 terrestrial examples:
While the previous example was already getting quite personal, giving the feeling you are texting with a real person, the next example actually feels like a real human. It is a digital human that acts and reacts in REAL time, as a real person - translate this to the situation on Mars, talking without delays to your virtual doctor, your human-like doctor.
These are just 3 examples of advanced Artificial Intelligence that are already a reality, but there are so many more centered around health and care, around the world.
This has been termed the “unbundling of the hospital” (Zayna Khayat), where AI is taking over specific bits of work traditionally being done by nurses or doctors. All these things could function on Mars. These initiatives are not yet focused on delivering healthcare in space, but what if you are an astronaut on your way to Mars - imagine you have all of this in your pocket. …Talk about medical autonomy!
I would love these two worlds to work together a lot more. For Earth applications space is a wonderful metaphor. If we can keep people healthy in space, imagine what we can do on Earth, in remote areas, or just around the corner... Moreover, we can learn from designing for the extreme, in a sector where just like healthcare, safety is always on top of mind. What would happen if we put the astronaut, a spaceship or Mars in the middle of this diagram above?
For one of my global virtual programs around healthcare applications of exponential technologies, we on one occasion invited the space sector. It resulted in a valuable mutual exchange of insights, but this was just one time... Imagine if these people meet on a regular basis!
So let’s go back to our ambition to explore space and our need for medical autonomy. I’d like to make this learning cycle and transfer of knowledge happen. Today I only mentioned solutions using Artificial Intelligence, but of course we will see efforts in Virtual and Augmented Reality, 3D printing and more, benefitting health up there in space and down here on Earth. Would you like to learn more about what healthcare innovation on Earth has to offer for space?
Feel free to reach out to me and let’s see what we can do!
As ESA-sponsored Dr Stijn Thoolen comes closer to the end of his year at the Concordia research station in Antarctica, he begins to reflect on his experiences of the last year and the journey homewards. Enjoy the rest of his fascinating blog series by following the links: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9, Part 10
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
Concordia, October 4, 2020
Sunlight: about 14 hours per day
Windchill temperature: -85 °C
Mood: excited, but there is a pinch of nostalgia. Already…
It’s 1:00 AM. I am lying outside on the roof, together with Ines (glaciologist), Elisa (cook) and Andrea (vehicle mechanic). There is a full moon shining on us, and Mars is right next to it. I am not much of an astronomer, but its bright color stands out so clearly from all the other celestial objects that even I can recognize it instantly as the Red Planet. Looking to the southwest I see Jupiter and Saturn. Also pretty hard to miss. Usually that is where I find the Milky Way, but there is too much light now, even at this hour. An amber color brightens the horizon, beyond which I now realize again there are just so many miles of ice (something easily taken for granted here, but thinking back to that inbound flight to Concordia last year does the trick) separating us from the rest of the world. In front of it all, I look at the frosty metal bars, which always looked so surrealistic to me when I saw pictures of them back home. They have gone through winter as well…
The return of the sun was cool. ‘Here comes the sun’ (you know, that one from the Beatles) was heard all over the station while we impatiently and excitedly tried to catch a first glimpse of it mid-August. Since that moment the skies have become more and more blue, and the snow more and more bright. I have experienced the gradual return of daylight over the past weeks with a positive and fresh feeling, and a sense of anticipation has started to take hold of the station. Who are the people who will replace us? What are our plans after Concordia? I remember myself some weeks ago, lying in exactly the same position as I am right now, outside against a snow dune, sheltered from the wind and with a pleasant -50 degrees Celsius (I realize this perception must be taken relatively…), alone, and just letting the sunshine touch my face again. A special moment, that reminded me of how pleasant summer conditions are going to be.
But funny enough now, here on that roof, I actually recognize myself trying to enjoy the last bits of darkness instead. Winter is over, and the light at the horizon is making sure I realize it. It makes me think of those unbelievable starry skies that I will probably never see again. Clear, twinkling, full of ‘falling stars’, here and there a satellite passing by, and dominated by the humbling Milky Way and it’s two neighbouring Magellanic Clouds, which are actually other galaxies we gazed at with our naked eye! Being outside at night has been an impressive experience, every time again. I remember the pictures I tried to make some time ago, outside on my slippers, with pain in my toes and barely feeling my hands, but all overruled by the excitement to capture all those incredible stars and some vague aurora dancing around it. I am probably going to miss the night sooner than I sometimes like to think…
As a crew we have made wonderful memories as well. This evening for example I think we all felt that. We organized an ESA quiz some hours ago, revealing some particular results from the human research we have been doing here (‘Who lost the most weight?’, ‘How much DC16-poop will be sent back to Europe?’, ‘What is the most recurring motive on food pictures: pasta, pies, or middle fingers?’, you get the idea…), and reminding ourselves of some good moments we had this past year. Not just happy birthdays or rather inspiring Saturday night dance moves on ridiculous music in the living room disco, but much more sharing an extraordinary experience that only a handful of people will ever be able to grasp in its entirety, and perhaps most of all (and probably as a result of the latter) an endless amount of inside jokes. So different in nature, but unified through our experience.
Lying here, thinking about all these special moments and happy memories, I feel inspired and incredibly lucky to witness all this. An incredible place to teach us about the world we live in, and a beautiful moment of realization to which I decide to hold on as much as I can under the rising pressure of the upcoming summer. I wish I could share it with the people at home…
How will it be to go back home? Maybe not that easy after all. The experiences we undergo here are intense, and it may actually be a challenge to make others at home understand what we have gone through, and make them feel the way we have felt. I will miss the night. I will miss our shared experiences. Left alone with those strong memories once we reintegrate into our old lives, Concordia may be hard to let go of. Perhaps Concordia now may become the place where we feel better understood, and I guess it is for this reason that many eventually make the decision to go back. Our Italian station leader appropriately calls it ‘mal d’Antartide’. Having been here four times now, he understands as no other this strong feeling of nostalgia for Antarctica.
When we go back home we will find ourselves in the richness and beauty of our old lives on one hand, but always carrying Concordia in the other. Torn apart between two worlds, each with its own treasures, and the combination of which is only understood by you…
We welcome back helicopter flight physician Dr Alessandro Forti, as he recounts the true story of an incredible mountain rescue in the Dolomites. We never truly know when we wake up each morning if this could be our last day of life - we assume that all will be well - as did a keen mountaineer in Italy, whose life unexpectedly hung in the balance and in the responsible hands of a Helicopter Emergency Medical Service team with a Lucas device!
Do also take a look at Alessandro's previous blog, which began his dream to work in the rescue services.
We describe here a case of full neurologic recovery from accidental hypothermia with cardiac arrest, which involved the longest reported duration of mechanical cardiopulmonary resuscitation (CPR) and extracorporeal life support (8 hours, 42 minutes). A 31-year-old man experienced a witnessed hypothermic cardiac arrest with a core temperature of 26C° (78.8F) during a summer thunderstorm on the vertical wall of the Marmolada mountain in the Dolomites, Italy (Figure 1), in the late afternoon on a summer day (day 0).
The trapped climber was secured on the wall without any form of waterproof clothing and reportedly had already lost consciousness in the few minutes it took his companion to reach him. The companion signalled for help, using a light on his smartphone device directed toward a nearby mountain hut. The local helicopter emergency medical system was called (7:20 PM) (Figure 2).
FIGURE 2: Course of treatment. HEMS, hospital emergency medical system; CA, cardiac arrest; VF, ventricular fibrillation; ACLS, advanced cardiac life support; ECLS, extracorporeal life support; CRRT, continuous renal replacement therapy; NAVA, neurally adjusted ventilator assist; CPC, cerebral performance category
A physician-staffed helicopter reached the scene at 7:42 PM, and the unconscious patient was immediately evacuated with a 30-m winch operation. The helicopter landed nearby; the initial cardiac rhythm was a low-voltage ventricular fibrillation (7:48 PM). Resuscitation manoeuvres started immediately with manual CPR, followed after a few seconds by an electrical shock (200 J biphasic); mechanical CPR was started after one complete cycle of manual resuscitation. CPR was continued with a mechanical chest compression device (LUCAS 3; Physio Control, Redmond, WA); initial end-tidal carbon dioxide (ETCO2) level ranged between 14 and 22 mm Hg. At 8:20 PM, the patient was transferred by helicopter under continuous mechanical CPR to the spoke Hospital of Belluno, Italy (43 km; arrival at 8:34 PM), as a direct flight to the hub Hospital of Treviso, Italy, was impossible because of the darkness.
On arrival, the patient’s core temperature was stable (26.6C° [79.9F]) and cardiac output under continuous CPR was considered sufficient (ETCO2 22 mm Hg); therefore, in accordance with the local protocol for refractory hypothermic cardiac arrest, the patient was transferred to a road ambulance and transported to the hub hospital (Treviso, Italy; 83 km) under ongoing mechanical CPR; meanwhile, the extracorporeal life support team was alerted. After the patient’s arrival (11 PM), venous-arterial extracorporeal membrane oxygenation (ECMO) was commenced (11:30 PM). Core temperature (esophageal) was 26.1C°. On day 10, there was a partial recovery of the ventricular function (left ventricular ejection fraction 40%) and ECMO was removed. On day 21, the patient was extubated; cerebral performance category score was 1, with only mild retrograde amnesia at day 28. Three months and 10 days after the accident, the patient left the rehabilitation unit and resumed normal daily life activities, with only minimal impairment of short-term verbal memory.
After one year the patient and the companion return to the place of the accident and with an US film factory and Stryker filmed a documentary about this event.
Space psychology is an extremely significant area of study. Combining insights from all areas of the wider field (i.e., organizational, industrial, cognitive, psychiatry), it aims to optimise human behaviour and cognition in space.
In terms of its history, space psychology has received varying degrees of attention over time. Whilst its importance was acknowledged at the inception of NASA in 1958; in the early 1990s Dr Patricia Santy (a NASA flight surgeon and psychiatrist) illustrated the industry’s relative disregard for the area, claiming that the application of psychology to space was running 20-30 years behind most other areas of medicine. However, with ever-increasing pressure from academics (i.e., the Committee on Space Biology and Medicine), the establishment of continuously inhabited long-term research stations with multinational crews (i.e., with astronauts joining cosmonauts on Mir in 1993, and the first stay on the ISS in 2000), and a number of high-profile incidents, for example, the theorised termination of the Soviet Soyuz T14-Salyut 7 mission due to depression and the attempted murder by astronaunt Lisa Nowak, the relevance of psychological issues has become increasingly pertinent.
Research within the field is predominantly focused on ensuring selection/training programmes prepare astronauts for the psychological demands of space travel, developing effective inflight support strategies and helping individuals re-adapt following their return to Earth. Studies can be conducted both in-orbit, and in terrestrial simulators and space analogs (i.e., undersea vessels and polar outposts), which attempt to produce a degree of environmental realism, and have aided in identifying the consequences of the intrapsychic/interpersonal stressors that astronauts encounter, such as team conflict, impaired communication/”psychological closing”, social isolation, threat of disaster, high-stakes/demanding work, public scrutiny, microgravity, radiation exposure, immobility etc... Such research findings can then be applied to develop models of successful crew performance (i.e., in terms of gender composition, and types of goals) and produce effective intervention strategies, like enhancement medications and therapeutic software. For instance, optical computer recognition scanners have been developed by NASA to track astronaut facial expressions and assess potential changes in their mood, allowing for personalized intervention strategies (i.e. computerized CBT treatment). Notably, whilst much research focuses on studying/overcoming the negative aspects of space travel, a robust finding is the salutogenic “overview effect” (White, 1987), which refers to how viewing the Earth from space fosters a sense of appreciation/wonder, spirituality and unity amongst crew members. It is theorised by Yaden et al. (2016) that this emotional reaction is a result of the juxtaposition between the Earth’s features and the black backdrop of space, which emphasises the beauty, vitality, and fragility of Earth.
With forecasted missions focusing on the potential for interplanetary (and eventually interstellar) travel, we need to prepare accordingly. Not only will these missions be much more protracted in terms of their distance/duration (with the longest period spent in space currently standing at 14 months, and a round trip to Mars predicted to take 2.5 years), they will also be subject to the pressure of larger, multinational crews, with no hope of evacuation, lack of protection from the Earth’s magnetic field, and distance-related communication delays (averaging 25 minutes to Mars/500 minutes to Neptune and back). Additionally, astronauts will not be able to observe the Earth and derive the aforementioned associated benefits of this experience; coined the ‘Earth-out-of-view phenomenon’ (Kanas, 2015; Kanas & Manzey, 2008), which may magnify potential feelings of homesickness and isolation. As such, we need to develop effective strategies to counteract these novel stressors, with researchers considering the benefit of fitting protective outer shields to isolated parts of spaceships (where astronauts spend the majority of their time) in order to mitigate against the effect of radiation from cosmic rays, email messages that conclude with suggested responses in order to reduce communication times, and virtual reality systems/on-board telescopes to minimise feelings of separation from Earth.
Having discussed the historical development of space psychology, the scope of research conducted, and the forecasted future of the field, I hope I have impressed on you the significance of such an exciting area of study. Managing human behaviour in space is an interdisciplinary effort, and as the government monopoly on spaceflight diminishes (i.e., with the launch of commercial/private space ventures like SpaceX), and the number/complexity of missions increases, the importance of space psychology will become ever more apparent.
ESA-sponsored Dr Stijn Thoolen delivers the last part of his 'Let's Talk Science' blogs, written during his year at the Concordia research station in Antarctica. Catch-up with his previous blogs at Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8, Part 9
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
But there is more to the ESA lab, and I have saved the best for last. So, now that you are probably overloaded with theories and facts, let’s talk about something very different. Let’s talk about sex!
And before we continue, you have to promise me to turn on another song, to end this blog with some appropriate groove.
But maybe there is more to it than it seems, and what Cherry-Garrard says is not necessarily easy to do. We are human, after all. Sexuality is one of our core features, vital for our existence, and for many it is a fundamental source of pleasure, intimacy, bonding, and social relations. Researchers have shown how sexual deprivation can lead to frustration, anger and even depression, and also seen from a group perspective anecdotal accounts have shown that sexual desire and related feelings of jealousy and competition can lead to adaptation problems in extreme environments. Including Concordia!
But the problem with sex it that we don’t easily talk about it. Perhaps it is so close to our core that opening up about it can make us feel vulnerable. A sensitive topic, and while researchers are currently busy figuring out how to compose future space crews in terms of culture, personality and gender, data about sexual behaviour and its effects on team dynamics in extreme environments is basically non-existent! How do we cope? How, why, and when do we suffer? Recent political debates and scandals of sexual harassment have already highlighted the importance of having a work environment free of sexual hostility, and if you ask me, it would be irresponsible to send humans on a multi-billion dollar long-duration mission to Mars without being able to answer these questions!
As such, the project SWICE (‘sexual well-being and sexual security in isolated, confined and extreme environments’), for the first time in spaceflight research history, is breaking the taboo. As the first study of its kind, it aims to gather basic information about human sexuality while living in isolation and confinement, and it does so by making us in Concordia talk:
‘How often does another Concordia inhabitant asks me for sexual favours?’ (we better forget the jokes at the dinner table…), ‘How often does another Concordia inhabitant produces sexually explicit graffiti for display at Concordia?’ (we better forget the sexually explicit Play-Doh creations we made with the whole crew last month…), ‘How enjoyable is your sexual life right now?’, ‘How often do you masturbate?’, ‘How often do you experience an orgasm?’ (Damn, you want to know everything!).
We had a structured anonymous interview (you know, like in the movies, with voice distortion and stuff) before we came here, and we will repeat it upon our return to Europe. Meanwhile, here in Concordia we fill in questionnaires throughout the year that look much like the above. And to make sure that everyone feels safe and confident to provide such sensitive data, and as I don’t want to know how the others here spend their free time, we all got an iPad to send the data directly to Berlin. This way everything stays anonymous. Still, answering these questions are good for a solid lesson in shamelessness I would say! Everything for a safer, healthier, and more successful environment, and again, for the good cause of science!
And with that I think you have heard enough ESA lab, and enough material to ponder upon. So now you know a little more about the challenges that we face here and what keeps me busy so far from home, I can only encourage you to appreciate the things we sometimes miss here, and enjoy the environment you interact with. Take a deep breath of oxygen-rich air, get yourself dirty every once in a while, find some fresh food, explore the beautiful and ever-changing world around you!
If someone asked you – “what do you want to do when you become an adult?" – what would your response be?
Now, imagine me as a 14-year-old student at an art school, and one day going to a Red Cross course and recognizing that you love the idea of the First Rescue and Emergency services. My first answer was always – Astronaut! But… what should I do now? Astronaut or Doctor ...?
Solution? Helicopter flight physician!
But how can I do this thing…is it possible? Yes, it is!
I first studied medicine and became an anesthetist and intensivist. And so it was… once I graduated and then specialized in anesthesia, I began to frequent the world of Helicopter Rescue. A fantastic job that combines flight, wonderful landscapes (the Dolomites ...) and the human factor. A lot of different situations every day and in different places. The helicopter flight physician is responsible for providing casualties with emergency medical assistance at the accident site, as well as attending to patients during primary and secondary missions. The scope of activities also involves recovering patients from topographically difficult terrain by means of a rescue hoist. This applies exactly from the time the patient is put into your care until you hand them over to the medical staff responsible at the destination hospital.
I remember one early afternoon in September 2013, the Helicopter Emergency Medical Service (HEMS) Dispatching Centre of Treviso, Italy received a call from a person who told the operator that her cousin, a 53-year-old man with a previous history of inferior myocardial infarction, had suddenly fallen down while walking at home. While dispatching the nearest ambulance, the dispatcher provided CPR pre-arrival instructions to the caller, according to standard protocols. An EMS helicopter, staffed by an emergency physician (namely, me!) and a nurse, was dispatched to the scene. The first emergency unit, staffed by a nurse and an emergency technician, reached the patient within 10 minutes of the call and found the woman performing chest compressions as instructed by the dispatching center operator. My team in the helicopter reached the patient 10 minutes after the first unit started ACLS (Advanced Cardiac Life Support). The cardiac rhythm was a persistent ventricular fibrillation and the decision was made to apply a LUCAS-3 chest compressions device to the patient, who was then transported directly to the hospital and catheterization laboratory. Selective percutaneous coronary angiography was performed with ongoing continuous mechanical chest compressions. Coronary angioplasty was performed on two coronary arteries. Five days after resuscitation, the patient was extubated and was alert and oriented. After 16 days he was discharged from the Intensive Care Unit and transferred to a post-intensive care unit. The patient survived without any neurological damage despite prolonged resuscitation and a call-to-ROSC (return of spontaneous circulation) interval of nearly 2 hours. The immediate beginning of chest compressions by the caller and uninterrupted CPR by medical teams preserved the brain from ischemic damage.
The mechanical chest compression device permitted safe and effective CPR during helicopter transportation directly to the catheterization laboratory, which permitted the removal of the coronary artery occlusions, which were preventing the ROSC.
This is why I think this is an amazing job…
A little about the author: Alessandro Forti
As well as being a certified specialist in Cardiac-Anaesthetics, Intensive Care Medicine and Aerospace Medicine, currently working as an intensivist, cardiac-anesthesiologist and HEMS doctor in northern Italy, Alessandro has a passion for space clinical medicine, which began in 2012 following a post-graduate course in Space Medicine at the San Donato Milanese University.
He has been involved in space medical research as a COSPAR (Committee on Space Research) collaborator and acted as a reviewer of many scientific articles for the journal Advances in Space Research (Elsevier). He was also Coordinator of the HEMS base in Pieve di Cadore-Italy from 2018-2020.
Alessandro is Principal Investigator for the research Mechanical Cardiopulmonary Resuscitation in Simulated Microgravity and Hypergravity Conditions: a manikin study, which took place during the 4th. parabolic flight campaign in Dübendorf (CH) in June 2020, in collaboration with the SkyLab Foundation, CNES and DLR.
His main areas of interest are space clinical medicine, CPR in different environments (mountain, avalanche victims, hypothermia, hyper and microgravity), ongoing CPR with ECMO (Extracorporeal Membrane Oxygenation) neuroprotection and neuromonitoring during DHCA (Deep Hypothermia Cardiac Arrest) in Cardiac Surgery.
We continue to follow along with the wonderful experience of ESA-sponsored Dr Stijn Thoolen during his year spent at the Concordia research station in Antarctica. Catch-up with his previous blogs at Part 1, Part 2, Part 3, Part 4, Part 5, Part 6, Part 7, Part 8
Dr Stijn Thoolen
Medical Research Doctor, Concordia Research Station, Antarctica
Fortunately it is not all body fluids (and solids) in the ESA lab. Other projects are more interested in the psychological adaptation to space-like environments. How do we deal mentally with the isolation far from home, the confinement, monotony, and life in a small international crew? The experiences and stressors that crews face during such missions require a certain degree of mental resilience, or may otherwise result in cognitive or behavioural problems and a loss of performance that can be dangerous to both the crew and the mission. To facilitate such psychological adaptation and resilience, the scientists behind MINDFULICE (‘role of mindfulness disposition in an isolated and confined environment’) for example are investigating the use of ‘mindfulness’ as a tool for deep space missions.
‘But isn’t that something for Buddhist monks?’, I hear you question…
I actually like to think it is quite the opposite. And although maybe it isn’t an easy construct to grasp, we are all already mindful to a certain degree. Perhaps it is best to think of it as a mental process, of being aware in the present moment, welcoming what is new with an intention of kindness and compassion, and being open-minded enough to see new possibilities in any given situation rather than relying on what you have previously learned. Everyone does that to a certain degree, but everyone can also learn to do it more.
Perhaps that is the biggest reason that the concept is gaining so much popularity so quickly. In our stressful and busy lives, mindfulness helps us to see solutions rather than problems, and research has already demonstrated many of its benefits, spanning from health and well-being to even business and artistic endeavours! A mindful attitude has shown to reduce stress while increasing resilience, task performance, enjoyment, psychological and even physical well-being, and in general a higher quality of life. That, I would say, is the promising power of the mind!
So can mindfulness also help astronauts to cope with the harshness of a deep space mission? We like to think so, but to find out we must first understand how it relates to stress and psychological wellbeing in such conditions, and Concordia serves as the ideal testing ground. Of course that means more tests for us, so over the year we fill in questionnaires and perform attention tasks to determine how mind- and stressful we actually are. And how about you? Are you mindful enough to one day float to the stars?
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