International EM, Wilderness Medicine

Think Like a Guide: Lessons Learned the Hard Way on International Expeditions

Whether you are heading out on an international research project, volunteer medical mission, CME adventure travel trip, or just a vacation to a new corner of the globe, think like a professional guide. These lessons from international wilderness expedition leaders will make you more independent, capable, and confident on your next adventure.

Tate Higgins and Will Hockett were full-time expedition guides before medical school and have 2 decades of experience between them in leading remote and international excursions. Learn their hard-earned tips for making the most out of your international rotation, medical mission, or off-the-beaten-path vacation.

TH: Write down important contact information on paper -- actual paper! Carry the paper with you in a gallon-sized water-tight bag, along with a paper copy of your passport. Once while working in India, I got off an all-day train ride and realized I had gotten off at the wrong station! My phone was dead, no WiFi, and no open shops. Luckily I had written down the contact info of the driver who was supposed to pick me up. I asked some locals for help and they called the number on my paper and explained to my ride.

Keep a paper backup of all the important things. Your phone is a good place to store tons of information. However, you need a hard copy of lodging addresses, tour operators, plane tickets because your phone is going to die when you need it most.

WH: Most international flights have 22 kg baggage limit. For expedition climbing or international medicine, your gear will add up quickly. Consider wearing your boots on the plane. Once you pass security, switch to flip flops and put those boots overhead. Luggage restrictions can be more flexible abroad. However, if you find yourself needing to take a bush plane or helicopter, weight limits can become very strict and you may be asked to leave gear behind if they are overweight.

TH: Travel is a great place to disconnect from electronics. However, when you’re a guide, communication is essential for safety and logistics. I usually change my cell phone into airplane mode and use it to connect to WiFi for email, messaging, and Facetime only. Just be sure to stay in airplane mode to avoid accidentally connecting to local cell service and incurring international roaming fees. WiFi is becoming more and more widespread across the world - which came in handy when I needed to coordinate an emergency helicopter evacuation in Nepal.

Consider buying a local cell phone or SIM card with prepaid minutes for voice calls. When I first started guiding in East Africa and Nepal, I would buy a local cell phone for both in-country communication and to call home because the rates were so much cheaper than my U.S. carrier’s international plan.

WH: Moving at altitude takes time and you’ll need more than just your medical kit in the event of a medical emergency. Make sure you have the layers you need to survive, plus some extra layers for the patient. If you do have to package a patient for evac, make sure to use their gear and not your own. Take it from someone who lost a new ArcTeryx jacket, if you send something with the patient you won’t get it back.

TH: Luggage gets lost! Pack essentials like hiking boots, medications, eye glasses, and electronics in a carry on. In a city like Kathmandu, Nepal, Arusha, Tanzania, you can find a huge market of slightly used outdoor and travel gear. Items like broken-in boots or medications may be more difficult to replace.

Book your return flight with a little buffer whenever possible, especially if you are traveling in remote parts of a foreign country. Weather and travel delays are common. In the mountains of Nepal, I’ve been socked in by fog that meant an extra 2 nights in the mountains and a chartered helicopter to finally get back to civilization. This can be a fun bonus adventure if you’ve budgeted a buffer at the end of your trip, but devastating if you miss your international return flight.

WH: “In the event of an emergency, stop and roll a cigarette.” I’m not advocating smoking, but this was the best advice an older guide gave me. On a trip, you might see an accident or hear a cry for help. Pause and take stock of the situation. Take a deep breath, exhale, and check your own pulse. When you’re first on the scene you need to be a rescuer, not an additional victim.

TH: Get training in wilderness medicine and carry a personal first aid kit at all times, stocked with any medications that you need or expect to need. In addition, add othre basic supplies such as tape for blisters, bandages, etc. For an organized trip, find out what type of expedition first aid kit is supplied. If headed to extreme high altitude ask about a Gamow bag and oxygen tanks. No matter what is provided, have your own basic kit so you don’t have to go to the guides for every blister or headache.

WH: Try out all of your gear before you leave home. A big trip is a great excuse to upgrade your gear and buy something new, but test it before traveling. Load backpacks with all of the gear you expect to carry and then take some laps around the neighborhood to get the fit adjusted. A little bit of effort before you leave can make a big difference in comfort during your trip.

The primary reason I have seen clients turn around are blisters. I had a Denali client spend a year training, a month acclimating in Ecuador, but no time in his new boots. He lasted 2 days on the trail before he needed to turn back.

Plan for the worst. In the comfort of your home, it’s easy to imagine committing to sitting through a storm. At high camp, with -40 wind chill and a tent that needs to be dug out around the clock, it’s a lot harder to wait for a weather window. Bring the best chocolate, book, or card games you can and keep your mind happy.

TH: Read the pre-trip information packet. Do not skim it; read it all! Things like strict weight limits for luggage are important; pack and weigh your gear before you leave, and count on the limits being enforced.

Be flexible. Be humble. Remember that it’s about the journey, not the summit. It’s easy to get super-focused on a specific goal, but it’s often the in-between days that are the most magical and rewarding.

Pearls: 6 Items Guides Always Have in Their Backpack

1. Foul weather gear: Guides don’t even check the weather forecast, they just assume that it’s gonna get worse, and pack for it.
2. Snacks and water: Pack the snacks you can’t live without and have a method such as chemicals or UV to treat your drinking water while traveling.
3. TP/personal hygiene kit: If you need toilet paper then you should carry it with you.
4. Buff or bandana: Multipurpose dust shield, sun shield, and headband.
5. First aid kit: Have a kit and carry it with you. Doesn’t do any good if you leave it at the hotel.
6. “Sacred socks”: Reserve a pair of socks (or T-shirt or base layer) only for sleeping. At the end of a long day, being able to change into one semi-clean item of clothing can feel like a huge luxury and boost your entire outlook.


Tate Higgins is a river guide, high altitude trekking leader, and wilderness medicine instructor. His recent research centered around wearable technology and sleep changes in the high altitude traveler.

Will Hockett taught leadership skills and mountaineering education on several continents. The best part was never the summit, but about the people he shared time with along the way. The adventure is reaching new heights with medical school.

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