Games are just part of the story for Youth Olympics CMO
Earlier this year, 1,100 young athletes from 71 countries traveled to Lillehammer, Norway, to participate in the Youth Olympic Games. The elite event is held in staggered summer and winter events and is organized by the International Olympic Committee. At the 2016 winter games, Sonya S. Ahmed, MD, an orthopaedic foot and ankle specialist who practices in San Diego, served as chief medical officer (CMO) for the U.S. team.

Dr. Ahmed describes the experience as enjoyable, but taxing. Her work days began at about 6 a.m., with her last patient contact usually occurring after 11 p.m. Before heading off to bed, she and her staff would gather to plan for the next day.

"We had a space in our quarters to see patients, but most of the time we were on-site, and it was cold," she said. "We would scatter ourselves at the events, some of which were held in different cities around Norway. Generally, I took on the higher risk sports. If something happened, I would escort the team member to the hospital. We worked very closely with the Norwegian doctors. I was allowed to write my own prescriptions, so that saved a lot of time."

According to Dr. Ahmed, transportation proved to be an unexpected challenge.

"We didn't have access to a car," she said, "so if I was in Jovik and someone got a concussion in Lillehammer and had to go to the hospital, I'd have to take a bus to meet our athlete. That could take several hours. The athlete would be escorted by another staff member, but for any major decisions they were required to have the CMO on-hand. So it was logistically quite interesting."

General medicine
Dr. Ahmed explains that taking the position of CMO also meant stepping back from specialization and revisiting a more general approach to medicine.

"When you're chief medical officer for the team, you're everything," she noted. "I had a few months to prepare, but I definitely had to brush up on my internal medicine skills. There are kids with gastroenteritis and strep throat, sexually transmitted diseases, as well as conditions in which I'm well-versed, like concussions and broken bones. But some aspects of primary care I hadn't done in 7 or 8 years."

High levels of contact between athletes and the close nature of the accommodations meant that any infectious disease could spread rapidly throughout the Olympic village.

"The athletes stay in dorms, four to a room," said Dr. Ahmed. "If they have something viral that can spread, you could have an epidemic within a day, so you have to act quickly and isolate people, but you also have to know when not to isolate. You ask yourself: Is this something that can spread or a reaction to something someone ate? If it's food-related, is it something that may affect others, and should we be prepared for that?"
In addition, Dr. Ahmed notes that Olympic rules regarding performance-enhancing drugs put pressure on healthcare providers to find alternate approaches to treat simple conditions.
"Things you wouldn't expect are on the forbidden drug list, so you have to be extremely careful," she said. "Something as simple as a cough drop, if you don't know what's in it, then you don't give it, because something may test positive. And with all the work they've put in to get there, that's the last thing you want to do to the athlete."

Relationship building
In traveling to a different country, the U.S. medical staff took the opportunity to build relationships with local healthcare providers.

"We arrived a few days before the games started," said Dr. Ahmed, "so we traveled around and introduced ourselves. We thanked the local doctors and nurses for hosting us and brought a few mementos from the United States. We tried to build a collegial atmosphere. You're in their country after all. It's their house; it's their hospital."

Despite the cold, the transportation issues, and the long hours, Dr. Ahmed says she wouldn't have to think twice if asked to serve again. She would do so "in a heartbeat," she says.

"It was a good experience for me, learning to deal with conditions I wouldn't normally treat here in the states, like frostbite and hypothermia," she noted. "They told me it was the warmest winter they'd had in a while, but it was still very cold and windy, and you spend a lot of time on the tops of mountains.

"But I would definitely do it again," she added. "I might prefer the summertime though. It would be a different experience to do summer, because you'd see different topology; heat exhaustion and heat stroke and hydration issues. It challenges you to be a better physician and learn ways to take care of the athletes and keep them healthy in whatever the environment dictates."

Peter Pollack is the electronic content specialist for AAOS Now. He can be reached at ppollack@aaos.org