Newsletter 214 May 2010
Fresh snow and medical matters
On Sunday, we woke up to a thick coating of snow covering the entire Himex base camp, and our first move was to clear the snow from the sagging tents this morning. The fresh snowfall has also affected the movements of our team up at Camp 2, and those members of our group, who were supposed to climb up the Lhotse Face to Camp 3 today, will now have another rest day at Camp 2 before they are due to move up on Monday.
The climbing team has been at Camp 2 for three days now and most of the members are acclimatising pretty well. On their way to Camp 2, they had to cross the scorching Western Cwm, where temperatures can soar up to 40C degrees due to its bowl-like shape. Camp 2 is nestled on top of the Cwm and offers amazing views of Mount Everest, Lhotse, the third highest mountain in the world, and Nuptse, which with just below 8,000m does not belong to the giants of the world but is certainly a very beautiful and pretty challenging mountain.
While the team is waiting to move further up from Camp 2, Russell, Monica, Lakchu, Phuri, Pasang, Nima and I have been re-organising base camp. As we are camped on a glacier, which is composed of rock and ice, the earth beneath us is constantly moving. This means that the bases of the tents have been melting away over the past few weeks and have to be re-filled with rocks. After about one hour of shifting rocks, we all realised how much work it must be for the Sherpas to set up our base camp at the beginning of the season. “The Sherpas must be moving tons of rocks to get the camp as flat and organised as it is,” an exhausted Monica said.
After having spent the whole morning to level the base of our mess tents, Monica went on to re-organise her medical kit, which has given me the incentive to inquire more about high altitude medicine. It is amazing to see how many drugs, syringes, bandages, splints and other gizmos there are in our little hospital tent. “We need to be prepared for everything – be it a simple cough, a broken arm or, of course, altitude sickness,” Monica said.
There are certain electronic devices from which climbers can see how well they are acclimatising. One of them is the ‘pulse oximeter’, a little machine which can read the oxygen saturation in your blood by sticking it on your finger. At base camp at 5,350m, the saturation should be around 70 to 80 percent. “Many people become obsessed with the numbers without really understanding what they mean. Really, it is just one piece of the jigsaw puzzle. Many of our strongest Sherpas often only have an oxygen saturation of between 60 and 70 percent. It is a good guideline but it does not mean anything on its own” said Monica.
Monica has worked as a doctor for Himex since 2007, and she has been on four expeditions – three to Mount Everest and one to Cho Oyu in Tibet. Altitude-related illnesses are the most common problems on the mountain, but they are closely followed by minor upper respiratory tract infections and mild cases of gastroenteritis. “I have rarely had to treat a serious case of High Altitude Pulmonary Oedema (HAPE) or High Altitude Cerebral Oedema (HACE) nor have I had any cases of serious frostbite in our own team.”
Monica puts this down to Russell’s good acclimatisation programme as well as the fact that there is always enough oxygen to treat the patients and there are always enough Sherpas to help altitude sick climbers down. “Once the patients arrive back at base camp, I am able to treat them with drugs such as dexamethasone, and give them oxygen – but ultimately most altitude sick climbers have to go down to a lower elevation in order to recover,” she said.
Since last year, when Himex shifted to the south side of the mountain in Nepal, Monica’s workload has changed a bit. “On the North side, climbers from other teams used to come to me for advice. This is not so much the case here, as there is a clinic at base camp,” she said.
The Himalayan Rescue Association (HRA) Clinic, which has become an integral part of base camp, was set up by the American doctor Luanne Freer in 2003. “In 2002, I trekked to base camp, and when I saw that there were no medical facilities, I decided to set up a clinic,” Luanne said.
About four weeks after the start of this year’s climbing season, Luanne and her colleague Steve have seen about 240 patients. “Most of them came with simple colds, however, we had one kitchen boy who suffered from serious HAPE and we saved his life. These cases make having the clinic absolutely worth it as I know that the boy would not have survived without our help,” Luanne said. The clinic charges western climbers a consultation fee of USD $100 per season, whereby local Sherpas and porters are treated for a nominal charge of about USD $3.
Even though Russell has his own doctor, he is very much in favour of the HRA clinic and makes a generous donation every year. “I think it is important to have this clinic at base camp, and if the doctors decide to charge a flat fee for every expedition per season in the future, I would still be happy to pay it – even though I would still bring my own doctor. The clinic is not only important for western clients but also for the Sherpas and porters,” he said.
Sherpas and porters are also an important part in Monica’s daily work as a doctor. “They often have cuts and blisters on their feet as they are carrying heavy loads up and down the icefall and constantly working very hard,” she said. “And sometimes they also suffer from altitude-related illnesses.&rdqo;
Nowadays, many high altitude climbers take Diamox, a diuretic drug that speeds up the process of acclimatisaion. Some doctors back home prescribe it to prevent high altitude sickness, however, Monica does not think this drug should be taken to assist the acclimatisaion on Mount Everest. “Diamox is very important for the treatment of acute mountain sickness but if you are here to climb Mount Everest, you should acclimatise without it,” she said.
Other than treating patients at base camp, Monica’s is busy preparing the various medical kits at the beginning of every season. She has three types of medical kits – a base camp kit, a portable kit for the trek to base camp, and several high altitude kits for the higher camps. “It takes me about three days to get everything ready, but at the end of the day I only use about 20 percent of the drugs. I have drugs for heart attacks, intravenous antibiotics etc, however, I don’t need them on most expeditions,” she said.
Monica does not climb to the higher camps with the team, however, she is always available on the radio and ready to give advice if there is a problem with a client, Sherpa or guide at the higher camps. “I don’t need to be up there. The guides and Russell have a lot of experience in dealing with high altitude sickness and I completely trust their judgment. A short radio conversation is usually enough for us all to reach the same conclusion about a patient.”
Asked whether she was scared of all the responsibilities as an expedition doctor, Monica replied that she was not really that worried about it as Russell ran such safe expeditions. “Of course, sometimes it is scary as I am dealing with young and fit people who should not be sick, in an environment where resources are limited, but ultimately I am confident that we do a good job of keeping people well.”
So far, everyone at base camp and Camp 2 is well and does not need any serious medical attention. Let’s hope it will stay this way – I will keep you posted!