Field Journal

They say that being a good doctor boils down to just four things: shut up, listen, know something, care.

The same could be said for life on the road, too.

When Stephen Fabes left his job as a junior doctor and set out to cycle around the world, frontline medicine quickly faded from his mind. Of more pressing concern were the daily challenges of life as an unfit rider on an overloaded bike, helplessly in thrall to pastries. But leaving medicine behind is not as easy as it seems.

Stephen Fabes spent six years cycling the world, visiting 75 countries and pedalling over 53,000 miles. As he roved continents, he encountered people whose health had suffered through exile, stigma, or circumstance – and others whose lives have been saved through kindness and community. Returning to his role as an emergency room doctor in London in 2016, Stephen wrote his book, Signs of Life, which challenges us to see care for the sick as a duty born of our humanity and our compassion.

We spoke to Stephen about his book, his experience travelling the world, and his more recent reality in frontline medicine.

In the opening pages of your book, you share the quote from travel writer Tim Cahill stating that ‘an adventure was never an adventure when it was actually taking place, to him, an adventure was only one after the fact, it was “physical and emotional discomfort, recollected in tranquillity”.’ How has your adventure changed you in the years since returning home?
I’m hopelessly wistful, of course! I miss the minimalism enforced by my panniers, and I miss a life that seems so loose and simple now that I’m back working as a doctor in the emergency department. But I have a selective memory, I’m sure. I tend to forget what it felt like towards the end of the journey. After 86,000km on trails and roads, I was burning out. I’d crossed 102 international borders and a similar number of cranky immigration officials. I’d camped for free by roadsides for over 1,000 nights too – though this is a statistic I enjoy to recall, because it reminds me of the freedoms of a long bike ride, and of a world more dependable than I’d ever imagined.

I’ve been wondering too about what happens when you treat wanderlust with travel. Can you purge it from your system? Or will it get worse, like with those rudderless souls I met during the course of my journey, relentless travellers who had little sense of home or community, and no stake in anything? For me, I’m mostly glad to be back, sifting through memories, translating them into words on a page. And I’m humbled by how the adventure was made possible. In almost every nation as I rode, countless strangers lent me places to sleep.

You’ve been on the front lines of this pandemic as an A & E doctor. How did your time cycling around the world shape your perspective in this global pandemic?
More than anything, it reminded me of how connected and how similar we all are (as trite as that can sound). I arrived home in early 2016, that trembling year. A turning point for me felt like a tipping point for the world. There seemed to be a mood of division in the UK, escalating nativism, talk of deep-rooted differences between human beings. But I arrived home preferring to think of us – all of us – as more similar than different. Perhaps this is because I’d spent a great deal of time contemplating healthcare as I travelled, and this stressed our similarities and trivialised our distinctions, dealing, as it must, with the raw machinery of our humanness, our blood and bones. I had been privy to a great deal of everyday life from the saddle of my bike too – it was a reminder that the fundamentals of all our lives are the same.

I dwelled a lot on borders as I travelled, of course – I crossed a lot of them! Borders are often blamed for many of the frictions of the world. I wonder now whether it’s our reverence for them or our hesitance to bridge them that matters more.

Part of my journey meant visiting medical projects and exploring the health gap: the wide disparities that exist in health, between nations, and within them. To insist that COVID-19 is a kind of useful spotlight on issues like these makes my heart sink. We’ve known all this for years and mostly we have failed to act in any meaningful way. Underfunded public health, understaffed hospitals, inaccessible healthcare: these things can have tragic consequences, especially in times of crisis. COVID-19 just shows us, again, that the most vulnerable suffer most – in their health and means and capacity to act.

As well as a seasoned traveller and cyclist, I also became a writer during the course of my journey. Writing has changed my outlook in equally vital ways. It’s cathartic, it helps me make sense of things, it encourages me to question, and it has been a great source of comfort during the most stressful days on the front line.

Mainstream adventure culture appears to revolve around firsts or fastests, and so many adventurers are desperate to find something that’s never been done. Meanwhile, cycling around the world is nothing new, yet it seems to hold a high appeal – why do you think it calls so many hearts? Is there something special about this specific way of seeing the world?
Frankly, if that’s mainstream adventure culture, you can have it! Happily, I think adventure culture is evolving, though. Exploration is being interpreted more broadly, and adventures are beginning to explore social and environmental issues in genuinely engaging ways, capturing imaginations in the process. In a surgical sense, an ‘exploration’ is an investigative operation, and I see this notion mirrored in some of the best modern expeditions. Much of what I found most fascinating during my ride came from uncovering commonalities and connections – and this became a kind of adventure too.

In his commencement address to UCLA medical school, the writer and physician Atul Gawande asserted that ‘curiosity is the beginning of empathy’ – this seems to me one of the most important truisms of medicine, but it’s relevant to the world of adventure too. After all, what’s adventure if not a kind of high-octane curiosity for the world, and the feelings it can muster? So can adventure produce empathy? Maybe not if you’re racing through, looking inward and learning nothing.

In recent Guardian articles, you write beautifully about your adventures and also your work). What do you think the role of the travel writer is in the modern era?
Not to centre themselves too much. Cycle around the world for six years and you owe the reader an explanation, of course – some notion of what you’re hungry for, what propels you – but as my book evolves, I try to get out of the way somewhat and turn the lens on people I meet along the road. The role of the writer is the same as it’s ever been: follow your nose, get under the surface, learn, seek a new perspective, come home, tell the tale. If you can entertain people a bit along the way, even better.

An excerpt from Signs of Life

The next day I continued west, and by nightfall, near Hpa-an, I was ducking behind some bushes to conceal my campsite. Inside my tent, I could hear men’s voices. They came and went and popped up close by. Footfall too: slow, determined steps. Psychopathic steps. All went quiet again until a dog stalked over, a Doberman, probably, rabid and toothy, with yellow eyes. It had just the bark.

This primal sense of dread was one of many reasons I’d fallen in love with camping stealthily on the edge of towns. Sleeping in this liminal space can feel as heady as camping in the wild, especially when it’s against the law, as it was in Myanmar. There was a feeling – during these nightly detours – of stalking society. It felt thrillingly outsiderish: I was the thief at the window. Childishly fun, like a game of hide and seek.

I was rough sleeping around the world as much as cycling around it: both defined my journey. Usually, it was easy enough to find a patch of earth to call my own, but I fancied myself an expert now. To dodge detection, I was strategic (camping high beats camping low, for instance, people look down at things more often than up at them). Pitching your tent is best done on the cusp of darkness too, when you can evaluate your campsite before night falls and hides you away. Camp too early and you risk getting spotted, camp too late, when it’s dark, and you’ll inevitably wake up the next morning beside a sign saying ‘Warning. Mine clearance in progress’.

Of all the nights I’d spent hiding away in my tent, most had been lost to memory, though a few I recalled as glorious victories: the Jordanian clifftop; the Californian sea cave; the centre of a French rond point; the ramparts of a ruined Ottoman castle. Others I remembered as stonking defeats, and I’d catalogued these as if they were dated horror movies: The Night of the Fire Ants (El Salvador); The Dawn of the Scorpion (under my Therm-a-Rest, in Argentina); and The Midnight of the Flood (Australia). On this occasion, when the footfalls turned out to be a few, wandering kids, and not an axe-wielding sociopath, there was a sense of escape that washed away all the fear and seemed to make the whole process ecstatically worth it.