***** June class is now JULY 3-17 2004

January 2005 medical student/resident class is a GO Yay!

Note the Marine WM/Dive Accident Management class & Expedition/Missionary Medicine classes now offered!

Note that we are doing a back-to-back Rescue class with the Medical class in July!

Read everything below with care! It answers many questions.





These unique rotation experiences combines didactic teaching and guided independent study with actual field training in wilderness and tropical medicine; wilderness, cave, and river rescue; and related disciplines. The field portions of the programs will be conducted in the Central American country of Belize at the training center for the Belize Institute for Tropical and Wilderness Medicine and the Belize National Disaster and Rescue Response Team. Students will participate in hands on practice of relevant skills, extensive field problems and exercises, small group problem solving, and participants may have the opportunity to work in on-going research projects and other special opportunities. Clinical time in the Belizean health care system may also be arranged.

Our programs are intended to provide participants with the a background in, the basic knowledge and skills, and appreciation of the problems encountered in wilderness & tropical medicine, rescue, international health, and third world operational planning. It is hoped that this will inspire some of them to continue such efforts in the future.

Several programs are offered each year including Wilderness & Tropical Medicine programs for resident physicians, medical students, and other health professions students; several levels of Wilderness-Cave-River Rescue courses (often in conjunction with the medical courses to allow a full month rotation); specialty courses such as Maritime Wilderness Medicine & Dive Accident Response, Wilderness EMT & First Responder training, Advanced Clinical Practicum & Research opportunities; and we are now excited to be offering a unique Expedition & Missionary Medicine class for physicians and advanced practice providers. Individual course descriptions are given below.

These rotations are sponsored by The University of Nebraska School of Medicine Department of Family Medicine, and the University's Office of International Studies & Programs. They carry the line number "FMED-750 International Health Elective" and grants credit for both required and elective class-work at lower, upper, and resident levels. Students from nearly two dozen medical schools and four foreign countries have participated in our programs. 2004 is the ninth year we have offered training in Belize.

Formerly known as British Honduras, Belize is a beautiful Central American country that is primarily rainforest and low mountain ranges, with the world's second largest barrier reef just offshore. The country is a safe and stable democracy, full of welcoming and friendly people. These are a mix of Mayan Indian, Spanish, African, and European descent. English is the universal language and taught in the schools, although Spanish, Creole, and several Mayan dialects are often spoken at home. The population is semi-literate, often not getting past grade school, and some of the remote Indian villages may have little access to education. Belize is grossly under-served in the area of health care, with a severe shortage of hospital beds, physicians, and basic technology. Patients often have to travel several hours to receive care. Diseases of poverty and tropical diseases are common problems, as are accidental trauma (especially motor vehicle accidents), agricultural injuries, wildlife "interactions" & snakebite, and drowning.

Our Sibun River Training Base is set in the Cayo district of the Mayan Mountains, surrounded on all sides by rainforest, Mayan ruins, sinkholes, and caves full of Mayan artifacts and remains. The facilities include classrooms, bunkhouses, bathhouses, kitchen and dining area, an excellent swimming river, etc. Construction and expansion of this facility is ongoing. This facility is located on the 58,000-acre property of Caves Branch. The jungle lodge business of Caves Branch has donated property and a tremendous amount of financial resources to supporting the rescue team you will be training with. All course fees for this rotation will also go to supporting our health projects in Belize. Room and board fees include meals, non-alcoholic drinks, local transports, etc. Go to: to see pictures of the jungle lodge, Mayan caves, rescue team in action during Hurricane Iris, and much more!

Below are files* of information about our programs, including a brief fact sheet that covers costs & logistics, curriculums for both the basic and advanced programs, and a student information packet that discusses how the programs are conducted, gives equipment recommendations, etc.

Please feel free to contact either the University's Office of International Studies & Programs or the program director, Dr. Keith Brown for additional information. Dr. Brown can be reached at [email protected].

2004-2005 Course Schedule

July 3-17 - Wilderness & Tropical Medicine Rotation - Combined upper & lower level program, already filling, get on the list soon.

July 19-28 - Wilderness-Cave-River Medical Rescue Level 1 - Basic technical rescue skills for medical providers & rescuers, already filling, get on the list soon.

Dates Pending Late September - Maritime Wilderness First Responder & Dive Accident Management - Enrollment via prior approval only, limited student slots available

January 2005 - Wilderness & Tropical Medicine Rotation- Combined upper & lower level program, already filling, get on the list soon

March 2005 - Expedition & Missionary Medicine Level 1 - For experienced physicians and advanced practice providers only

July 2005 - Wilderness & Tropical Medicine Rotation - Combined upper & lower level program

Course Descriptions

Wilderness & Tropical Medicine Rotation

The Wilderness & Tropical Medicine rotation will provide both basic and advanced wilderness and austere medical skills & knowledge needed to recognize and stabilize life threatening illness and injury, as well as treat a variety of common minor problems. Basic search and rescue skills including an introduction to jungle, cave, and river rescue as well as personal safety and survival skills are integral to providing effective care in wilderness and international settings, and will be practiced extensively in the course, along with basic disaster response, improvisation of medical and rescue materials, and related topics.

This class is designed for resident physicians and medical students, but we have also had - on a case by case basis - Paramedics, EMTs, technical rescue personnel, select pre-health profession students, and a few outstanding civilians successfully complete the program. If you are interested, please inquire if this class will meet your needs - Wilderness First Responder and Wilderness EMT-B/P cross over certifications are available for participants holding those certifications.

The rotation consists of a minimum of two weeks of guided self-study conducted on an individual basis, coupled with practical field instruction in the country of Belize, Central America. The field portion consists of a fourteen-day module with one-two days off in the middle of the program. The program will be conducted at the Institute's Sibun River Training Base, a modern classroom & housing facility, with field exercises being conducted in the surrounding jungle, caves, and river areas. The field program is unique and very challenging - physically, but even more so mentally and emotionally - you will face challenges unlike those that you have faced before - and emerge a much stronger medical provider, technically and personally. The difficult challenge this program represents is a consistent theme prior students have commented on - and they have universally praised not only what they have learned about medicine, but what they have learned about themselves. Final written evaluations of the participant's performance will be submitted to their institution at the completion of the program.

***** Note: This program is physically demanding - you do NOT need to be a world class athlete - but you do need to be able to walk up and down steep muddy hills with the equivalent of a 15-20 pound pack in high heat and humidity, function in dark and narrow spaces for brief periods, and be able to swim in water deeper than your height with the aid of a life jacket. You WILL get soaking wet, covered in mud, hot, cold, bruised & scraped up, and bug bitten - you can't do wilderness medicine without being in the wilderness! All of our students to date have had little problem in meeting these challenges.

Instructors for this program are physicians and Paramedic instructors with extensive real world emergency medicine, wilderness, developing country, and teaching experience who have been working in Belize and around the world for many years. They are assisted by other specially qualified staff, including selected honor graduates from prior programs, Belize National Cave & Wilderness Rescue Team medics who have completed an instructor development program, and other personnel with areas of special expertise.

All specialty gear and equipment will be provided. All students will be issued a rescue/caving helmet, webbing, rope, jungle hammock, and life jacket for use in the program. Students are responsible for all other personal gear as specified in the individual equipment list provided to you.

Join us for the adventure of a lifetime! Contact us for an application and a specific course information packet. Read this carefully before applying. We will interview by telephone all applicants to ensure that you understand the course intentions and limitations to ensure that this program will meet your needs and expectations.

Wilderness & Tropical Medicine Advanced Clinical Practicum & Research

This elective rotation is for students and resident physicians who have completed either our initial Wilderness and Tropical Medicine rotation, or have equivalent training, as approved by the instructional team. This elective gives participants the opportunity to develop both their applied knowledge and practical skill base through participation in additional training programs as well as participate in adjunct instructor and teaching assistant roles. Participant's exact roles and duties are designed through individual contract with the instructional team, and will vary according to the desired goals.

All programs will have components of assigned readings, oral and practical examinations, and a final project evaluation. Duration is flexible. Final written evaluations of the participant's performance will be submitted to their institution at the completion of the program. The instructional team is headed by Board Certified physicians holding faculty appointments at the University of Nebraska School of Medicine and/or other institutions, and is coordinated in Belize through the Belize Institute for Tropical and Wilderness Medicine.

Wilderness-Cave-River Medical Rescue Level 1 Rotation

This series of courses is designed to complement the wilderness medicine courses by providing additional training in the technical aspects of patient access, stabilization, immobilization, and evacuation. Wilderness, remote, austere, and disaster medical situations often require extensive rescue and evacuation components to save lives. Medical providers require a basic knowledge of the technical aspects of the rescue component, as well as advanced skills and experiences to be able to successfully integrate medical care with the rescue process.

The Level 1 course introduces technical rescue concepts and equipment, safety of all procedures and operations, and basic patient immobilization, vertical hauling systems, and movement through confined spaces, water hazards, and difficult terrain. This course is primarily conducted through extensive field learning exercises. This course is often offered in conjunction with (either before or after) the wilderness and tropical medicine class to allow participants to gain the full introductory experience to wilderness medicine and rescue.

Advanced rescue classes in technical rescue, river rescue, cave rescue, and rescue leadership are also offered to those with appropriate qualifications. Please inquire if interested.

Maritime Wilderness First Responder & Dive Accident Management

This course is an introductory program focusing on the basics of saving lives and treating critical medical emergencies in, on, and around the marine environment. It uses demonstrations and discussions of important areas followed by extensive practical teaching and practice to ensure mastery of both concepts and skills. This class is specifically designed to be "Belize appropriate" in both how it is taught and it's content. This class will be specific for the needs, resources, and capabilities of Belizean students and the local environment.

It's target audience is Belizean tourism and diving personnel, marine research personnel and support staff, coastal fisheries, law enforcement and Defense Force personnel, marine and coastal NGO staff, national disaster and rescue personnel. A small number of selected North American medical providers may also be invited to participate on a space available basis.

Expedition & Missionary Medicine Level 1

A unique program offering the specific medical assessment, care, and evacuation techniques, skills, and knowledge needed for use in expedition, wilderness, remote, austere, and/or disaster conditions. Emphasis will be placed on improvisation and application of concepts with extremely limited resources under challenging conditions. Both "low-tech" and "high-tech" solutions will be explored.

Conventional "urban" medical knowledge and skill sets are often unavailable, inadequate, even dangerous, when applied in austere settings. Physicians planning work or travel in these settings, be it as an expedition physician, for missionary work, research, or adventure travel need specific, proven, knowledge, skills, and experience to transition from their own area of expertise to the new paradigm of austere care. No class can entirely prepare you for any and every eventuality you may encounter. The purpose of this class is to give you specific skills - and experience in applying those skills under challenging conditions - as concepts that may then be adapted and applied under the widest possible circumstances.

This program is designed for experienced physicians and resident physicians in their final year of training, regardless of specialty. Experienced advance practice providers and remote duty medical personnel (e.g. special operations medics) are also encouraged to apply.

Physician and other provider Continuing Medical Education credits are available for this program.

The program is held in the safe and easily accessible Central American country of Belize, on the edge of the rainforest at our modern Sibun River Training Base. It consists of an 100+ hour program over 9 days. It uses demonstrations and discussions of important areas followed by extensive practical teaching, skills labs with simulators & volunteers, and practice to ensure mastery of both concepts and hands-on material. Teaching is done in the classroom, laboratory, and jungles, caves, and rivers of the area. Practical field exercises are designed to complement and reinforce critical concepts as well as allow participants to gain experience with field equipment under realistic conditions. While physically challenging at times, these settings are well within the capabilities of those with very average fitness. Our emphasis is on learning, not physical challenge. All specialized equipment is provided, and you will live, eat, and sleep in our modern facility equipped with a kitchen staff, hot water showers, and comfortable bunkrooms.

Areas of emphasis for this program are:

Expedition/mission planning and needs estimation
Self-rescue and personal survival skills
Use of specialized and highly portable equipment
Medication selection, durability, and storage
Proven protocols and solutions
Pain control, regional, and general anesthesia in the field
Field laboratory procedures & techniques
Patient movement and evacuation techniques
Extreme circumstance patient assessment, including remote assessment, hasty, confined space, and low-light examination, as well as low-tech and now largely forgotten bedside examination skills
Life-saving interventions for patients experiencing injury/illness in the "Big 3" body systems - the respiratory, cardiac, and neurologic systems - focusing on practical methods of assisting breathing, controlling bleeding, administering fluids, and managing spinal injuries with minimal (or no) equipment
Treating shock in the field
Managing fractures, dislocations, sprains and strains, including closed reductions and closed traction systems
Ophthalmic, dental, obstetric, and other specialized emergencies
Environmental emergencies including altitude problems, heat & cold emergencies, lightening injury, snakebite and insect injuries, burns,
Medical problems including stabilizing acute exacerbation's of chronic of cardiac, respiratory, neurologic, and metabolic conditions
Practical infectious disease and public health/sanitation/water purification skills
Improvisation of care materials, supplies, techniques
Assembly of your own medical kits and supplies using available materials, proper storage, etc.
And much, much more�.

Dr. Marshall Keith Brown
Board Certified, ABFP
Fellow, American Academy of Family Physicians
Assistant Professor, University of Nebraska School of Medicine
Medical Director, Belize Institute For Tropical & Wilderness Medicine
Medical Director, Belize Disaster & Rescue Response Team