Tag Archives: sports

My experience as a Volunteer Doctor at the Birmingham 2022 Commonwealth Games

Medicine, Public Health, Sport, Uncategorized, , , , ,

Noamaan Wilson-Baig

About me 

I am Noamaan Wilson-Baig, an anaesthesia and intensive care consultant at Wrightington, Wigan and Leigh NHS Foundation Trust. I am also an Emeritus doctor with East Anglian Air Ambulance and a council member of the Central Area division of the British Boxing Board of Control. I am due to start a role as a Medical Emergency Response Incident Team doctor with the North West Ambulance Service. Before working as a doctor, I was a Pharmacist for fifteen years. 

I applied to volunteer at the 2022 Commonwealth Games because I wanted to be part of something special. I wanted to experience the same fantastic opportunities as the volunteers from the 2012 Olympic games and showcase my skills as a pre-hospital doctor while acquiring new skills. Most importantly, I would meet some amazing people while on my Commonwealth Games journey. As part of the volunteer commonwealth collaborative medical team, I aimed to provide safe and healthy games. 

Application process

The application process began around 18 months before the start in late July 2022. I was a late applicant to the process. Unlike others who had to wait a while before hearing from the applications team, I was lucky to get a prompt response and was called for an interview. All applicants had to create a profile, including uploading a photographic ID and identity verification. All candidates had to answer questions about why they wanted to volunteer at the Birmingham 2022 games and what skills they could provide.

My interview was conducted via Zoom by a senior member of the medical team. The interview was an informal process which allowed the interviewer to find out about me and what I could bring to the games. My CV was explored, and there were some clinical-based questions. Those who had a face-to-face interview in Birmingham could explore the venues that would be used during the games and meet with other potential candidates.

Before the Games

Before the games, all volunteers had to attend some key training events in Birmingham. These included role-specific training and venue-specific training. The role-specific training was a half-day session and involved people from various sectors (medical, media, supporter services etc.). The role-specific training allowed volunteers to get a feel for the specific roles they would be undertaking at the Birmingham 2022 games. It was also an opportunity to meet fellow volunteers undertaking different parts. This was a perfect opportunity for volunteers to get a detailed brief of their role and what would be expected of them. The venue-specific training was held at venues where volunteers would spend most of their time at the games. In my case, I was appointed field of play team leader for boxing; therefore, my venue-specific training was held at the NEC. However, I was also due to cover the opening ceremony, netball, table tennis and cricket. The opening ceremony was held at the Alexander Stadium, while the cricket was held at Edgbaston Stadium.

The training events allowed me to meet with other volunteers, share experiences, and explore the logistics of accommodation, parking and travel to the venues. Unfortunately, the organising committee had not accommodated the volunteers, so this was a logistical challenge. However, all volunteers were given a free bus pass to travel from their residence to the venue where they would be volunteering. All necessary equipment and meals for when we were on shift would be provided. 

Although the games’ training events were helpful in some respects, I was unclear about the anatomy of a shift during the games and the exact processes involved should a critical event occur. The one thing that was made clear was that there were two discrete medical teams; one would cater for athletes on the field of play, while the other would cater for spectators. There would not be any cross-over of care unless there was an absolute life-threatening emergency.

To manage some of the concerns raised by volunteers, the organising committee set up WhatsApp groups for the various venues. It informed us of some unofficial Facebook pages to assist volunteers in finding and sharing information relating to volunteering at the games. I found this very helpful. Excellent advice was provided by those volunteers who had worked at previous games or significant events and those individuals who lived in the Birmingham area. Like most volunteers, I had not considered the financial logistics of volunteering at the games. Some individuals reported spending thousands of pounds on accommodation and taking unpaid leave. This was a real challenge for me as I could not afford this amount considering the current climate. I also lived in Manchester, so commuting would’ve been challenging. There was a point where I felt I might have to withdraw from the process due to the possibility of spiralling costs.

Fortunately, I could take leave from work, and a very close friend let me stay with him and his family in Bromsgrove, Birmingham, for the duration of the games. He also organised someone to taxi me to the various venues I would attend. I am so grateful for this support. Many others had similar support as me. It demonstrated how people came together to ensure the success of a global event. As a result, the total cost to me for the ten days was around £300. For anyone considering volunteering at large events, I would recommend considering the financial implications of volunteering as early as possible in the application process and what you can do to keep costs to a minimum.

The rosters for the games were released electronically around two months in advance of the start of the games. Volunteers had the opportunity to accept prescribed enrollments or pick up vacant shifts.

During the Games

My first shift was at the opening ceremony. I had only watched this on television before, so to experience this live while on duty was a fantastic experience. There was a sense of anticipatory excitement in the air. The success of the opening ceremony was a demonstration of how the city of Birmingham is a true reflection of its Commonwealth communities and how inspiring people created and achieved the story of Birmingham.

For the rest of the games, I got to work with some amazing people from all walks of life, including athletes, healthcare professionals, actors, prop technicians, security, accreditation team, catering team, games makers and many more…including the legendary Perry the Bull. During events, we were up and close to the action. My role on the field of play was Field of Play Team Leader (FoPTL), the medical team providing care to athletes. At the start of every shift, we would have a team brief to ensure who was present and what skills were available. We would then have a multidisciplinary discussion and simulation with healthcare professionals directly employed by the Birmingham 2022 Games organisation and the emergency services team provided by West Midlands Ambulance Service. This was essential to ensure that we could provide care seamlessly should it be required. As a spectator clinician (SpC), my role was similar to those working in an emergency department in a makeshift medical room. As a roving doctor, I would carry a radio and walk around a pre-defined venue area. This would allow me to be dispatched quickly to a referral from the area I was patrolling. If called, I would conduct a primary assessment and liaise with the game’s medical control room to discuss the next steps. This would be to plan whether the patient should be transported to the medical room for further assessment or to the local hospital via ambulance. 

In total, I covered ten shifts at different venues. The sports I covered as a FoPTL were boxing, netball, and table tennis. As an SpC, I covered cricket, badminton, weight lifting, netball and boxing. I met many athletes and national team medics during my time. I also got to experience sports that I had never watched live, e.g. netball. The atmosphere was electric when England was playing. The Birmingham 2022 Games opportunity also allowed me to explore other areas outside the medical sphere, e.g. the filming and televising of the games. I saw first-hand how sports television is assimilated and put together from various cameras transmitting unfolding events on the field of play. I did not appreciate the logistical intricacies of airing live sports on national and international television. When I was not on shift, I could watch other sports like hockey and basketball held at different venues in Birmingham.

As FoPTL, it was an absolute privilege to see, up close, athletes perform to the highest level in their chosen sport. I witnessed the highs and lows as athletes tried to win medals for their nations. I was fortunate to be rostered on the final day of the games at the boxing, which culminated in Delicious Orie winning the Super Heavyweight Gold. As SpC, it was amazing to experience the electric atmosphere from the crowd at various sports, especially when the home nations were performing. 

After the Games 

I have kept in touch with many fellow volunteers. Using Twitter, Instagram and LinkedIn, I have connected with volunteers and maintained contact long after the Games. I have also been fortunate to be invited to cover amateur boxing events due to the connections I made during the games. The relationships I made while working at the Games have given me excellent opportunities and many memories that will last a lifetime.

Advice to anybody considering volunteering

My advice to anybody considering volunteering would be – GO FOR IT! The Birmingham 2022 experience allowed me to see first-hand the effort and work that goes into putting on a global event and the work athletes do to perform at the highest level. 

My best memories? Seeing first-class sports, witnessing medal ceremonies, conversing with and having photographs with athletes. The icing on the cake was wearing a gold medal, playing table tennis with a former British table tennis Olympian, meeting with legends like Dame Kelly Holmes and getting to work with and conduct a medical on Perry the Bull. I cannot begin to describe the fulfilment I gained from this unique opportunity and the fantastic memories I have made. It was a bonus to network with other professionals and made lifelong friends. As an added bonus, I met with an old school friend I have not seen since 1990!

I would strongly advise you plan ahead for the logistics and financial implications of volunteering at global events. All I can promise is that you will have the best time ever. Please make the most of your once-in-a-lifetime opportunity; who knows where it may take you 

Should athletes be using Kambo?

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Recently there has been an increased interest in the use of Kambo. This interest has made its way into the sporting world. The following YouTube video https://www.youtube.com/watch?v=pEsUtZhnQoE&ab_channel=BBTVBOXING looks at the ceremony, reasons and effects of the “frog medicine” which is believed to have a number of physical and mental health benefits. However a disclaimer is provided which states “(NB this is not an endorsement or medically approved this is just a look at the practice for those who don’t know anything about it)”

In this blog, I discuss the issues surrounding Kambo in sport. It is written to create discussion. I would be interested in your comments.

What is Kambo?

Kambo (or Sapo) is the name of a secretion of the giant leap frog (Phyllomedusa bicolor) from the Amazonian forest. It was used for centuries by local tribes to enhance their “hunting” skills. The effects of Kambo were first described in 1925. These included nausea and vomiting. The use of Kambo has recently been advocated by those involved with alternative medicine and celebrities as a ‘healing’ intervention to cleanse the bodily systems [1].

Currently, only 16 known bioactive peptides have been isolated from Kambe. These include Adenoregulin, bombesin, bombesinnona peptide, dermorphine, caerulein, deltorphin, neurokinin B, phyllomedusin, phyllocaerulein, phyllokinin, phyllolitorin, preprotachykinin B, ranatachykinin A, sauvagine, T-kinin and urechistachykinin II [2]. There are many more as yet unknown compounds to be isolated.

The compounds described as enhancing stamina and better hunting skills may be a result of the opioid effects of dermorphine and caerulin. These compounds are reported to be 40 times more potent than morphine [3].

How is Kambo used today?

Kambo is used in a specific neo-shamanic subculture as a healing- intervention and as a method to “detox” the body [4]. A practitioner will use a burning vine to create a number of small burns on the skin, resulting in blisters. The blistered skin is then scraped off, and the Kambo is applied to the wounds. For more information see this website for sessions provided in East Sussex https://www.kambofrog.co.uk/

Although Hesselink [1] suggests starting with a small dose to assess for individual sensitivity – as higher doses may lead to severe adverse effects, there is no published evidenced based data on the dosing of Kamba. Also, and an important consideration, is the experience of the practitioner administrating Kambo. I am not aware of a certified and nationally recognised register of practitioners in administrating Kambo.

Apparently, there is a closed Facebook group where around 6000 participants are registered. Based on previous case reports, Kambo should not be used in those with cardiovascular conditions, psychosis, severe depression, bipolar disorders, severe anxiety, epilepsy, addison’s disease, low blood pressure, history of aneurisms, pregnancy, and children [1,5]. Hydration is an important consideration, however drinking too much water may result in the body retaining too much water due to the hormonal effects of Kamba (Syndrome of Inappropriate Anti-Diuretic Hormone secretion). This may cause cerebral oedema (increased fluid around the brain).

Adverse reactions of Kambo

These include nausea, vomiting, diarrhoea, abdominal pain, dizziness, palpitations, anaphylaxis, loss of bladder control, dehydration, muscle spasms and cramps, convulsions, jaundice, anxiety, and skin scarring [1,2,5].

Interestingly, Kambo is used by the Giant Leaf Frog to produce a “molecular electric shock” in a predator’s mouth, so it is quickly ejected. The poison works by overloading the predator’s internal system with chemicals, prompting regurgitation, muscle spasms, vomiting, and intestinal convulsion—hence the sick buckets at Kambo ceremonies [6]. Due to the neurochemical action of Kambo there could be an addictive nature to this drug – especially in view of the opioid effects. Anecdotal evidence suggests that individuals who use Kambo in the UK describe the desire for repeated use. Practitioners are keen to stress that dosing should be restricted to 12 times a year [6]. However, there is no substantiation of this claim.

Use of Kambo in athletes

While there has been a lot of anecdotal data on the use of Kambo, there is no scientific evidence-based research on the dosing of Kamba. Although some adverse effects are known (described above), we truly do not know the pharmacological effects of Kambo. Additionally, unlike registered practitioners in medicine, nursing etc, there is not (as far as I know) a legal governing regulatory body that oversees practitioners who administers Kamba. However, in the UK, there are a growing number of people conducting Kambo ceremonies, either trained in the Amazon or by the International Association of Kambo Practitioners (IAKP), which administers, teaches, and regulates the use of Kambo (https://iakp.org/). The IAKP already has 13 registered practitioners in the UK and more than 50 worldwide [7]. There are various websites that offer training (https://www.kambo-dots.co.uk/). However, I am unclear of what is involved in terms of regulating practitioners. This anecdote does not provide any confidence https://www.dailymail.co.uk/news/article-6817737/Woman-dies-alternative-kambo-ceremony-gave-heart-attack.html

We are all too aware of the hydration issues of athletes involved with boxing, especially on the run-up to an event. Considering the effects of Kambo on fluid-balance, this is something to be aware of. Athletes could end up having muscle spasms, palpitations and convulsions. However, on the other hand, the advice is that individuals should not drink too much because of the risk of a hormonal imbalance that can cause fluid retention (SIADH – described earlier). I therefore think that this agent should not be permitted in the sporting arena.

Another issue is related to the psychoactive nature of the bioactive peptides associated with Kambo. The IAKP denies it, but Kambo does, technically, have psychoactive properties. Kambo contains opioid peptides such as dermorphin, dermenkephalin, and the deltorphins, which are ingested via the burn points. These are potent opioid receptor agonists in the central nervous system, which by definition will affect the mental state of the individual. It is therefore not correct to state that these drugs aren’t psychoactive. Considering this, should athletes be using this agent?

On another note, we are all aware of the World Anti-Doping Code [7] with regards the use of narcotics and hormones. Although Kambo is not on this list, could some of the ingredients be considered prohibited under the umbrella of “All natural and synthetic….” (concerning stimulants and hormonal agents) or, in reference to narcotics “All optical isomers….”, or “all agents administered exogenously, but not limited to…” I am not an expert in this area, but considering what I have read, I do not think Kambo would be a permitted substance. This, needs clarifying. This substance could be considered in similar vain to the issues and legalities surrounding cannabinoids.

Finally, I am not clear of the legality of Kambo in the UK. What do we advise an athlete who used Kambo? My feeling is that it should not be used, especially as we do not know about the agent in terms of its dosing, pharmacology, safety and efficacy. I personally think that considering the contraindications to the use of Kambo, athletes should seek advice from their GP first before engaging with Kambo Practitioners. The addictive nature to Kambo may be a cause for concern for the athlete and the GP.

I do think that until we have a consensus on Kambo, or advice from sporting governing bodies, we should closely assess the athletes using Kambo at each event. I personally I think we should deter all athletes from using Kamba. There clearly needs to be a conversation about this. I am not sure how many people are aware of Kambo. I certainly was not until last week.

Further Reading – Schmidt, T.T., Reiche, S., Hage, C.L.C. et al. Acute and subacute psychoactive effects of Kambô, the secretion of the Amazonian Giant Maki Frog (Phyllomedusa bicolor): retrospective reports. Sci Rep 10, 21544 (2020). https://doi.org/10.1038/s41598-020-78527-4 https://www.nature.com/articles/s41598-020-78527-4

References

  1. Hesselink JMK (2018) Kambo and its Multitude of Biological Effects: Adverse Events or Pharmacological Effects?. Int Arch Clin Pharmacol 4:017. doi.org/10.23937/2572-3987.1510017
  2. Damila Rodrigues de Morais, Rafael Lanaro, Ingrid Lopes Barbosa, Jandyson Machado Santos, Kelly Francisco Cunha, et al. (2018) Ayahuasca and Kambo intoxication after alternative natural therapy for depression, confirmed by mass spectrometry. Forensic Toxicology 36: 212-221.
  3. Keppel Hesselink JM (2018) Kambo: A ritualistic healing substance from an Amazonian frog and a source of new treatments. Open J Pain Med 2: 004-006.
  4. Keppel Hesselink JM (2018) Kambô: A Shamanistic Ritual Arriving in the West-Description. Risks and Perception by the Users. Int J Psychol Psychoanal 4: 034.
  5. Wilson DR (2020) What’s the Deal with Kambo and Frog Medicine? [online]. Available from https://www.healthline.com/health/kambo [Accessed 9th May 2021]
  6. Daly M (2016) How Amazonian Tree Frog Poison Became the Latest Treatment for Addiction [online]. https://www.vice.com/en/article/gqkxa9/kambo-ceremony-alcoholism-purging-uk [Accessed 9th May 2021]
  7. World Anti-Doping Agency (2021). List of Prohibited Substances and Methods [online]. Available from https://www.wada-ama.org/en/media/news/2021-01/wada-2021-list-of-prohibited-substances-and-methods-now-in-force [Accessed 9th May 2021}