Students spell out APEX6

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The APEX adventure

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University of Edinburgh medical students are aiming high with their research expeditions to Bolivia.

At around 6,000 metres above sea level, Huayna Potosi Mountain in Bolivia seems an unlikely place for students to conduct medical research. In fact, the site, which is close to La Paz, the highest capital city in the world, was a carefully chosen location.

Students spell out APEX6
A dedicated team of University of Edinburgh students spent 13 days there earlier this year studying the effect of high altitude on a whole host of bodily functions as part of Altitude Physiology Expeditions, or APEX. As a charity, APEX aims to use the low-oxygen (hypoxic), high-altitude environment to create a unique opportunity for students to study the responses of the human body to these conditions and contribute their findings to medical research.

Into the unknown

APEX expeditions have been running since 2001. Every few years, a team comprised mainly of undergraduate medical students plans, co-ordinates and carries out an expedition to Bolivia. Dr Kenneth Baillie, Personal Chair of Experimental Medicine in the Centre for Inflammation Research at the University, was one of its founders.

Students look down on the vast city of La Paz
Dr Nina Rzechorzek, alumna of the University of Edinburgh and MRC Clinician Scientist in the MRC Laboratory of Molecular Biology in Cambridge, took part in one of the first expeditions as a student: “Delving into the unknown is addictive. Some 20 years ago, I was recruited as a Team Leader for APEX 2. At the time, it was the largest controlled-ascent medical research expedition to extreme altitude and it got me hooked on clinical research – especially the kind with complicated logistics!”

This year saw Dr Rzechorzek supervise a project for the APEX 6 expedition. She explains why she wanted to get involved: “APEX 2 was a life-changing and career-defining experience for me. I have always wanted to enable the next generation of researchers to have opportunities like this.”

Suzanne Green is Head of Volunteers and Communications for APEX 6 and a Year 5 MBChB Medicine student at Edinburgh Medical School. During the delay caused by the pandemic, she decided to go from volunteer to committee member for APEX 6: “I thought it sounded like an amazing opportunity to get involved in medical research as well as spend my summer meeting new people and travelling in South America. I applied to be a committee member because I thought it would be a challenge and give me insight into the world of medical research.”

Gemma Woodhead, APEX 6 volunteer and Year 6 Medicine student agrees: “I think the work from APEX 6 is important for students in order to give us opportunities to experience research and expedition medicine – both of these areas can be really difficult to get involved with.”

Different perspectives

This summer, 38 medical students gathered in La Paz, for the APEX 6 expedition. After five days spent acclimatising at 3,700 metres, the group set out for the base camp on Huayna Potosi. The camp at 4,800 metres was their home for eight days.

Students hold a Scotland flag
During that time, the group carried out six different research projects. Spending their days monitoring the effects of altitude on circadian rhythms, lung function, menstruation, and vision in the dark, the students were able to run and assist with certain projects while volunteering as participants for others.

“I was a participant in several of the research studies,” explains Gemma. “Practically this meant waking up and carrying out the reaction tests in the morning, filling in questionnaires, giving blood samples and having my eyes tested.”

Suzanne was the co-lead of the lung oxygenation project alongside Oliver Vick, the expedition leader, which looked to explore the effects of altitude on healthy lungs. She elaborates: “The project was created to investigate a new algorithm of calculating how well your lungs are oxygenating your blood. The current algorithm used in medical practice is known to be inaccurate for those with poorly functioning lungs. By using healthy volunteers, who have low oxygen levels due to being at high altitude, we can investigate this algorithm with less confounding factors and will be able to identify with more confidence the superiority of this technique.”

Gemma was also involved in the lab work for one of the projects: “This was my first experience of lab work and I found it enjoyable and rewarding to be involved in research that is very novel.”

Dr Rzechorzek is keen to emphasise that having exposure to research early on is key: “It allows students to broaden their curiosity, question the status quo, and realise the impact they can have throughout their career. Through leadership and teamwork, the students build resilience and develop an array of skills whilst organising an expedition – which is a mammoth task.”

Suzanne agrees: “Opportunities to get involved in research can be hard to come by and especially in extreme medicine scenarios. It allowed students to experience and get involved in medical research both from the perspective of a researcher as well as a participant.”

Vital research

So how can research projects conducted halfway up a mountain in Bolivia inform medical research and treatment carried out closer to sea level? Suzanne explains: “APEX has the capability to improve understanding as well as medical practice. You may think APEX studies are only relevant to those at high altitude, however, we also have applications to hospital medicine, sport and any disease or condition that causes you to have a low blood oxygen.

“Simulating a low oxygen state in healthy individuals allows us to conduct research with smaller sample sizes and achieve more definitive conclusions due to participants having less morbidities than those in hospital.”

Students conduct medical research
Dr Rzechorzek highlights that this research could even affect the students after graduation: “The circadian rhythm project is relevant to the volunteers as they embark on their career journey – clinical posts often involve challenging shift work patterns which we know can impact on physical and mental health.

“It will be immediately clear how the results of this study might translate to wider society where shift work patterns are common in many sectors,” she continues. “More than ever, we are recognising the importance of sleep and circadian health to the functioning of the brain and the body throughout life.”

Overcoming obstacles

Although volunteering for APEX 6 was an enlightening and valuable experience, the expedition certainly came with its challenges. Gemma shares more: “With it being such a remote area, and the symptoms of acute mountain sickness being miserable at times, it was really important for us to support each other. I think it proved to all of us that we were far more resilient than we had previously realised.”

For Dr Rzechorzek, the biggest challenge came before expedition launch. With the pandemic delaying APEX 6 for two years, the strain of constantly reorganising everything became a huge burden: “Frankly, I would have quite understood if the team had decided not to continue – several of the students progressed through the latter stages of their medical degrees during this time and faced not only heavy training and exam schedules, but also the difficulties of soaring flight prices and keeping their recruited volunteers on board and engaged.

“Some missed their own graduation for APEX 6 which shows what this experience meant to them and the sacrifices they were prepared to make. I remain astounded and inspired by the APEX 6 team who were utterly dedicated to their mission and refused to give up – and so neither did I.”

A unique opportunity

The commitment of everyone involved in the expedition, particularly whilst navigating the pandemic, ensured the success of the trip. Although the students learnt much from their research experience, an added benefit for many of them was a chance to push themselves and create new friendships.

A group of students walking on a mountain
For Suzanne, the expedition was an experience like no other: “APEX had a major impact on my life. There has been a lot of blood, sweat and tears from all the committee members, past and present, to allow this expedition to go ahead. It took a lot of my time, more than I care to think about, for the past two years and had its highs and lows.

“However, the skills I have learned along the way have been invaluable. I think they have shaped me into a more qualified and confident individual. One of the biggest impacts for me was that our volunteers enjoyed their time and want to organise another expedition; this is honestly the best feeling and validated all the hard work we put in.”

Alongside the excitement of taking part in and contributing to medical research, the expedition also had a social impact on the volunteers. Suzanne shares more: “APEX creates strong bonds and relationships. There’s nothing like being isolated up a mountain sharing one room to bring people together. We went from having a group of 38 people who didn’t particularly know each other to being a tight-knit group, irrespective of degree or age.”

“APEX teaches resilience and compassion,” she continues. “I found it incredible to see everyone taking the time to check in on each other and care for each other. We had an amazing sense of community.”

Reflecting on her experience of APEX 2, and comparing it to her role as supervisor for APEX 6, Dr Rzechorzek can only agree: “APEX 6 was an adventure on many levels; I have no doubt that this experience will have been transformative for all of the volunteers.”