Survival of the fittest

Volvo Ocean Race Medical Co-ordinator Timo Malinen gives us his angle on the bumps and bruises in this race

While the sailing crews steal the limelight in the Volvo Ocean Race, what is less apparent is the huge infrastructure in place to keep the wheels of the round the world race turning. One significant cog in this Volvo Ocean Race machine, particularly with a significantly faster boat now being used, is Medical Co-Ordinator Timo Malinen.

From Finland, a talented rock guitarist and also a sailor - he is one of VOR CEO Glenn Bourke's successful Laser SB3 crew - Malinen in normal life was once a physiotherapist, but is now a chiropracter, practising just outside of Hamble. But for the last two races Malinen has been an integral part of the Volvo travelling circus.

"The race provides care for the whole race community so at any one time we can have up to 2,000 people to look after, but I am not looking after everyone - we’ve got local providers in every port," says Malinen when we see him in his office, on the dock just next to where Ericsson has been lifted out of the water in Cape Town. "If a journalist gets poorly they look after them. I am mainly responsible for the sailing teams, their shore team and our travelling race organisation, to make sure the race continues..."

Malinen's job is extensive and includes setting up the medical infrastructure at every stopover, identifying local specialists, liasing with the local 'trauma centre' (known as Accident & Emergency in the UK) as well as restocking each boat's medical kit, liasing with the sailing teams and each boat's on board medics.

This being Malinen's second time in the role with the VOR, he has had the opportunity to make improvements to the medical side of the race. Whenever a team signs up for example they now immediately get presented with an impressive manual based on 12 years worth of experience and covering every aspect from injury prevention, to Grant Dalton's experience from past races, analysis of the medical problems experienced in the 2001-2 race, a piece by Malinen himself about back pain - the most common ailment four years ago. The all-encompassing book also contains information about cold weather injuries, nutritional problems, clothing and sleep management.

"Some teams in the last race thought that in a three week stopover they could get stronger," Malinen cites as an example of what they have learned. "That’s rubbish. All you can do is recover from the leg before and you can maintain, maybe some people can improve slightly, but on average they were training too hard in stopovers which means that they are more exhausted when they started sailing."

10 people spending a prolonged period in a confined less-than-hygenic environment presents some unique medical problems. "If one of the guys takes a common cold with them on board at the restart from here to Melbourne, that is not very nice," states Malinen. "As soon as they get four days out it is the cleanest place on the planet, but if you take something there, the whole crew is potentially ill for the whole two weeks they are going sailing."

Most of the day to day complaints from both this race and the last are typically sports, overuse type injuries. "Like any sports, depending upon the sport, you either get it in the wrist, shoulders, or tendonitis. One of the big ones was lower back last time - and it still is. Basically in sailing in general you have continuous bad posture - you can’t really stand upright most of the time. There've been some carpal tunnel problems, where the tendons, blood vessels and nerves go through the small channel inside your wrist. When you do the same sort of movement all the time, they grow and the area gets very inflamed and it is too tight for those and then you get pins and needles and numbness in your hand."

Then there are usual assortment of skin problems due to prolonged exposure to salt water that particularly affect hands and feet. Spotty botty, also known as gunwhale bottom, and other delightful 'fungal growths' have also proved worse this time again due to the much wetter environment on board the VO70s. "That seems to be quite a big one here as these boats are wetter, so even in hot climates you wear your foulies..." points out Malinen.

But the biggest change for this race is the level of what Malinen calls 'trauma', ie more serious injuries such as breakages and fractures, a result of the boats sailing at much higher speeds. Following the big first 48 hours on leg one there was physical 'trauma' of some description on almost all of the boats.



Grant Dalton is unloaded onto a stretcher with fractured ribs after the first Southern Ocean leg four years ago

"I feel that the motion of these boats is very different," explains Malinen. "The centre of gravity is in a different place to what it was. Now you cant the keel out so the boat’s movement is jerking and is a much harder movement. I have spoken to many different sailors who did the last leg about this: In the last race in the 60s you were still able to take a few steps without holding on to anything. Now you hold on to something every step of the way. This is one of the reasons why after the last race, when there were no handholds down below, our medical team recommended to the people who wrote the rule that they should have compulsory handholds down below which they now have got on all the boats. It’s fantastic. And there is a minimum length for the bunks now."

Malinen holds some strong views on how the teams should go about preventing trauma, echoing very much the same strategy ABN AMRO Two's Seb Josse and Simon Fisher described to us. "People keep on saying how dangerous and extreme these boats, but if you think about Formula One cars, they go faster now than they have ever done before, so you have to change the way you approach the subject. You can’t just expect that you don’t need to change: you improve the boat and you can do the same thing as you did before - that is not the case. So I am quite happy that at least one crewman has said to me how now when he comes on deck, if he goes in front of a mast, he always wears a helmet. Which is fantastic, that's exactly what we have been trying to do: prevention, make people aware of these problems. So what they need to do is to change their way they sail the boat. Instead of doing sail changes which are hard and on the wind, or whatever, slow down, do what you need to do, do the job, keep it safe, nice and simple - it might be slightly slower for those 10-15 minutes, but you haven’t lost a sail, lost a crew, you haven’t broken and you haven’t hurt anyone and you can still sail."

All the boats are now carrying helmets if not for the whole crew, for a least everyone in a watch. Malinen reckons that the level of 'trauma' will reduce as the race progresses as the team learn more about how to master their new beasts and implement more safety procedures. "You can’t sail a Finn like you can sail a Laser, despite them both being singlehanded one sail dinghies so you have to learn and these guys are learning. I wouldn’t be surprised if we see people having two strops on their harnesses so they are at all times clipped on. I have discussed with some of the crewmembers now and they say 'I’ll clip off the lifeline onto a padeye, so I’ll get something to lean back on'. But you take it off - and it is seconds you are talking about - but in that time a wave comes with 5,000 lt of water and…you’re gone."



Abuse of the on board medical supplies is also no longer happening, says Malinen. "[In previous races] some teams used to pop the odd pink pill - Ibuprofen or painkillers, they used to eat them like Smarties. So we have been bombarding them with advice and information on drinking, how to use drugs, how not to use drugs, when to use them, when not to use them, as part of our work with the teams and the on board medics are really good now. Most of them have written notes down, why they gave the drugs, who to and what for, how much was taken, etc. So they are learning what to do and they are not allowing the crew to go on their own to start looking at the stuff."

Part of this problem has also been dealt with by redistributing the on board medical supplies between a 10kg day box and the bulk of the medical kit, stowed in the lockable emergency compartment found on each boat alongside the emergency watermaker, anchor, etc access to which requires crew to get permission from Race HQ.

Following the incidents in the last race - most notably Keith Kilpatrick's blocked intensive during the second leg that required him to be taken off Amer Sports One - so they have also improved the medical supplies carried on board. "The medical kit is always a compromise," says Malinen. "It is a lot smaller than on the BT Global Challenge, but if you look at the injuries which happen, our injuries are different. These guys are athletes, they are young, fit. We haven’t got medical doctors on board, they mostly do including vets, etc. So the medical kit must be a compromise, you cannot cover everything, but then again we have got different types of antibiotics for different types of infections and problems. We have different antibiotics for people who are for example allergic to penicillin for example. They can perform minor surgery if need be. We try to be pro-active rather than reactive. We had to react last time to Keith Kilpatrick so we went from having enough fluid for one person for one day to having enough fluid for one person for a week. The first Southern Ocean leg the best predictions are 14 days, so if someone gets hurt in the middle of the leg they have enough fluid to either come back or continue or to get within helicopter range so that they can be taken off the boat."

The food programs on most of the teams has also progressed for this race. "They are taking more care of what they are carrying. Although there is still quite a lot of weight loss, that is not for a lack of food or nutrients like it was last time, it is because they are using more energy. So the biggest problem is getting enough food in - you can’t physically eat that much food. These guys eat about twice as much as we eat around 6,000 calories a day now how do you do that? It’s something like 11 Big Macs. But at least they are thinking about that."

Malinen is keen to stress that the medical side of the Volvo Ocean Race is a joint effort by his team and the race teams to learn, improve and hopefully make the race a safer place. This is one area of the race where the teams are not in competition and it is not a case of 'us' and 'them' between the race organisation and the teams - anything learned should be added to the information pool for the greater good.

To summarise Malinen says: "If you keep your boat in one piece, try not to lose too many sails because you haven’t got too many sails to lose, the crew that stays the fittest will win this race I reckon."