Are we still bad at space travel?

When astronauts get sick in space

COLOGNE. No doctor far and wide - in times of medical shortage, a sentence that many patients say they are familiar with. Even between Volker Damann and his patients there are sometimes a mere 400 kilometers.

To overcome it, however, he would need a missile. Because it does not go north, south, west, east, but steeply towards the sky - out into space.

Damann is a space doctor at the European Space Agency ESA. He heads the medical department at the European Astronaut Center (EAC) in Cologne, where astronauts are trained for their missions in space.

This training not only includes the specialist, technical knowledge for experiments on board the International Space Station (ISS), but also intensive medical preparation for the rigors of space flight and a stay of several months in weightlessness.

Always stay on the ground

Space doctor: that sounds quite aloof in the truest sense of the word. In fact, the radiologist Damann himself remains on the ground.

However, very few doctors come as close to space as he does, because there are only a handful of space doctors, says the 56-year-old.

The 25-person team includes three doctors, psychologists, physiotherapists, sports scientists, engineers and IT specialists are also on board. Or - to stay in spaceman jargon - on board.

The medical department is currently looking after six astronauts who are preparing for upcoming missions or who are already on the International Space Station (ISS). "That sounds great at first: three doctors and an entire team of specialists for six patients," says Damann.

But after all, caring for these patients of a different kind goes far beyond ordinary doctor-patient contact.

Müller welfare of the astronauts

Volker Damann

Volker Damann (56) studied medicine in Marburg, then initially worked as an assistant doctor in the Marburg University Clinic. Later he worked with two colleagues in a practice for radiology and nuclear medicine.

In 1989 Damann moved to the German Aerospace Center.

Damann has been with the European Space Agency ESA since 1995, and has headed the space medicine department since 1997.

"If an astronaut is nominated for a mission two years before the flight, a doctor and team are nominated to oversee the entire mission," explains Volker Damann. "He who learns and trains with, in order to gain an understanding of: What actually happens on the mission?"

The closer the flight gets, the more intensive the work becomes. "Like a team doctor before the World Cup," Damann cites as a comparison. "So we are a kind of Müller-Wohlfahrt, just not for the German national soccer team, but for the European space travelers."

Through the intensive joint preparation time, the team doctor gets to know his patient well, knows exactly how fit he is and where there may be small weak spots.

And that is also particularly important, emphasizes Damann. Because weightlessness will change the astronaut's body, even good fitness and strength training on board do not provide 100 percent protection.

"The images of weightlessness always look so easy and simple, and that's basically how it is, and that is exactly the problem," explains Damann. "The body adapts very, very well to the new situation."

For example, the heart suddenly no longer has to pump against gravity, and bones and muscles no longer have to carry body weight.

Muscle strength decreases

So cardiac output, bone substance and muscle strength decrease over time. A completely normal process, actually. "That only becomes a problem when you return to earth," says Damann.

"Our task is therefore to preserve the astronaut's health before the flight so as to have as few negative effects as possible from this physical degradation and to be able to rehabilitate more quickly afterwards."

The intensive medical care on the ground is also so important because once the astronauts have arrived on the ISS at an altitude of around 400 kilometers, they can no longer simply go to the doctor quickly for many weeks or even months.

The German astronaut Alexander Gerst was last in space for six months. That is why, of course, when making the selection, care is taken that the astronauts do not have any serious previous illnesses.

Nevertheless: "A technical system failure is much less likely than a failure of the biological system," says Damann. In other words: it can always be anything.

"We therefore train astronauts in such a way that they can provide first aid up to roughly the level of a paramedic as an extended arm of the medics on the ground if an emergency really does arise."

Specifically, this means: The space travelers learn to pull teeth, sew lacerations, care for burns and resuscitation measures.

There is also a kind of medicine cabinet on board with pills for coughs, runny nose, hoarseness, everyday ailments that can affect even the fittest astronaut. "There are also some prescription drugs in the on-board pharmacy that we can prescribe from the ground."

In the case of serious illnesses, the astronaut has to go back to earth

The medical care of the astronauts remains intensive on board, even if the entire earth's atmosphere is between doctor and patient.

There are regular medical consultations for every crew member, says Damann - 15 minutes a day at first, then weekly.

Of course, they don't run over a publicly accessible radio channel, but encrypted. Because medical confidentiality also applies outside of the earth.

The talks are not always just about medical questions, but also about workload or news from the private sphere, reports the ESA space doctor.

"We are also a bit of a liaison arm to the family, a person of trust."

All illnesses that go beyond small wounds or toothache, however, exceed the professional and technical possibilities in the space station.

"Then the astronaut has to go down to earth," explains Damann.

In the worst-case scenario, everything at ESA is strictly regulated: "It must be possible to bring the crew to a full care clinic within 24 hours, no matter where in the world they end up."

The ISS is still close enough to earth to be able to guarantee that in an emergency.

Doctor on board for the flight to Mars?

In future manned missions, for example to Mars, things will look different. Especially since the space travelers are faced with completely different dangers: such as extreme radiation exposure.

Even at the relatively low altitude of 400 kilometers, this is not without - according to Damann, it is in the order of magnitude of a lung x-ray per day.

A no brainer compared to the dose that would threaten a flight to Mars. We do not yet know everything about the long-term effects of radiation, both for the astronaut himself and for the next generation, says the radiologist.

So there is an urgent need to find technical ways to reduce radiation exposure during long space flights. But even if that succeeds: a mission to the neighboring red planet would take years. For years without a doctor - impossible.

Actually, Volker Damann believes, the key to the future of space medicine lies in the past: "Christopher Columbus already had a doctor on board. And if you look back in human history, there was always a doctor on board. Except in space travel. I think that future missions - to Mars or wherever - will have a doctor on board. "

The course for this is already being set. Damann is playing a leading role in setting up a new course at King's College in London, which aims in precisely this direction.

In the long term, he has a Space Medicine Academy in mind, where young people can pursue a career as space medicine doctor.

The chances are obviously not bad that future generations of doctors will come much closer to space than we can imagine today.

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