Tag Archives: Nepal

Lessons on Altitude Sickness from the Himalayan Rescue Association

Annapurna Base Camp, at over 15,000 feet

A group of us trekker are sitting in a circle in a health clinic in the town of Manang, which sits at elevation of 11,500 feet in the Nepal Himalayas. A few look drawn and tired; a young woman is complaining of headaches. Outside, a group of porters walks by, one with his head wrapped in a towel soaked in cold water. He insists he is okay.

What we are learning here, at this class for trekkers given by the Himalayan Rescue Association, may tell us otherwise.

The Himalayan Rescue Association was founded in 1973 as a collaboration among volunteer visiting doctors, Nepali health officials and doctors, and representatives from trekking companies. The founders recognized that Nepal’s trekking routes were drawing more and more tourists to the high altitudes of the Himalayas – but at a cost.

The most common trekking routes reach dangerous altitudes for inexperienced hikers: up to nearly 18,000 feet at Everest Base Camp and at the Thorong La on the Annapurna Circuit, and more than 16,000 feet on other popular routes. The first foreign visitors to these high mountains were skilled outsdoorspeople with experience at altitude. But as trekking became more and more popular among “lay people,” it became clear that many trekkers had no idea how to recognize and respond to the symptoms of altitude sickness. Some became seriously ill. Some died.

Mt Everest and Annapurna Himalayan Rescue Association Aid Stations

The first aid  station was opened in 1973 at the hill town of Pheriche in the Khumbu region, on Nepal’s Mt. Everest Trek, at an altitude of about 14,000 feet. During the trekking seasons, it was manned by volunteers who lived in yak herders’ huts and tents.

A second station was opened in 1981, in Manang, a town on the Annapurna Trek, a two-day walk from Thorong La, the 17,800-foot pass that is the Annapurna Trek’s highest point. In 2008, another aid station was opened at Thorong Phedi — the foot of Thorong La, the pass that is most dangerous on the Annapurna Circuit. At these aid stations, doctors provide education, screening, and treatment; if necessary, they also aid in rescues of afflicted trekkers.

Educating Nepal’s Trekkers About Altitude Sickness

Nepal’s High altitudes can be dangerous.

Where altitude sickness (also called acute mountain sickness) is concerned, prevention is always the best course of action. This is particularly true in Nepal, where rescue is difficult because there are no roads into the trekking areas. Air-rescue is expensive and often impossible because of weather conditions and terrain.

So the Himalayan Rescue Association program focuses on prevention. They publish a series of educational pamphlets, available in Kathmandu hotels and trekking agencies. And during the trekking season, doctors hold a daily lecture on altitude sickness at the hill-town aid stations. By screening trekkers as they come through the high hill towns, the Himalayan Rescue Association has been able to decrease the incidents of mountain sickness.

The lectures teach trekkers to recognize symptoms of altitude sickness, and stress the importance of gaining elevation slowly and taking rest days. This advice is particularly important on the Annapurna Trek, because the Thorong La reaches such high elevations, and on the Everest Trek, because today, many Everest trekkers fly to the airstrip at the high-altitude village of Lukla. They therefore forego some of the essential acclimatization that is one of the main ways to prevent altitude sickness.

Himalayan Rescue Association doctors also stress that Nepali porters and guides are also susceptible to altitude sickness. While many Sherpa people native to the Sol Khumbu region near Mt. Everest are well-acclimated to the high altitude, porters and guides from lower elevations near Pokhara or Kathmandu are often just as susceptible to altitude sickness as trekkers – but may be less likely to admit to it, since their jobs depend on their strength. Trekkers therefore, need to be alert not only to their symptoms, and those of their trekking partners, but to symptoms of porters and guides as well.

Volunteer Doctors and the Local Communities

In addition to providing preventative care for trekkers, guides, and porters, the Himalayan Rescue Association has done comprehensive research on the subject of altitude sickness. It also provides free and low-cost medical care to local villagers who live near the stations (sometimes, the staff even tries to treat sick animals brought in by villagers!). These are remote towns, far from any roads, and the health care provided by the volunteer doctors is the only western medical care available. Donations collected from trekkers are used to support the medical care given to local people.

Annapurna Circuit: Best Long Hikes in the World Series

I’m going to jump around the world in this series. Keep things interesting. Nepal is about as far away from where I live as you can get on this earth, and the Annapurna Circuit is one of that country’s iconic treks.

It’s a  three-week trip that circles around the Annapurna Massif, which are among the world’s highest mountains. Annapurna I is one of the world’s classic 8,000-meter climbs.

Logistically, this is an easy trek to arrange. From Kathmandu, you take a bus to Besishahar. From there, it’s a two-hour drive on a rutted, pitted, washed out jeep track to Syanje, where the trail actually starts. (You can also walk it; plan for a full day). Negotiating passage on a truck or four-wheel drive vehicle is generally possible because trekkers are a big part of the economy here. The details, while not exactly controllable (ours involved a drunk driver and a vehicle that had a slight problem keeping the engine running), do seem to fall into place, at least in hindsight. It didn’t seem that way when we were stuck in a creek without the proverbial paddle, and all of the trekkers were trying to push the stalled vehicle through the boulder strewn river-bed.

The general contour of the trek is to circle the massif counterclockwise by going upriver, trekking across a plateau, and then going downriver. (That summary is kind of like saying the Empire State Building is a building somewhere in New York.) The route begins with an ascent of the Marshyangdi River valley, with  views of  Manashlu and Himal Chuli. The trek rises from rice fields and forests to scruffier subalpine vegetation, following the same pedestrian routes of travel used by villagers. There are no roads.

The trek then veers west, to the Manang Valley, a windswept, sandy, rocky, avalanche strewn landscape inhabited by Tibetan Buddists. This is part of the Tibetan plateau, and indeed, Tibet is just over the mountain range to the north. The trail then crosses the Thorong La (“La” means Pass), which at 17,800 feet is the highest point on the trail. After Thorong La, trekkers descend to the pilgrimage site of Muktinath, then continue down the Kali Ghandaki Valley, the world’s deepest gorge, with jaw-dropping views of the fierce-looking Dhaulagiri. This part of the trek can be done as a smaller subsection by flying into Jomson then trekking down-valley: With many guesthouses and restaurants, it’s come to be known as the Apple Pie Trek.

Buying last minute equipment en route.

Traditionally, trekkers stay in the small villages along the route. If you’ve booked a commercial guided expedition, you’ll probably be staying in tents pitched for you by your porters. If you’re on a private independent trek, you can carry (or hire porters to carry) tents, or you can stay in tea-houses along the way. The majority of trekkers hire porters to carry their gear. This makes the trekking easier, and porters hired independently (as opposed to pre-paid commercial expeditions) cost only about $15 – $20 US a day, depending on the trek. A guide might cost $20 – $30 a day, and he can help negotiate transport and stays at tea houses, give you cultural insights, and help with route finding and logistics on the more remote routes.

If you do book porters and guides independently, check their high altitude equipment: Many do not have adequate equipment (sunglasses, boots, warm jackets, hats), and won’t let you know until you are dependent on them, in a remote village, where some equipment may be available for sale from enterprising locals at a high prices (which you, as the employer, will be expected to pay). Also be aware that they will expect tips. Going on strike in Nepal is a time-honored porter tradition: A commercial expedition costs far more than an independently arranged one, but makes this hassle someone else’s problem.

Another concern for all trekkers in Nepal is hygiene and health. Arriving in Nepal after having spent several months in East Africa, after having spent another several months on America’s Continental Divide Trail, I thought my resistance was up to snuff. Not so: I was flattened by severe stomach trouble within a day of my arrival. Living and hygiene conditions can be, quite simply, life-threatening in Nepal, which has one of the lowest life expectancies in the world. Use every food caution you’ve ever heard of and then some, from opening your own soda bottles to using your own utensils and never eating anything raw.  Our pampered western immune systems simply aren’t tough enough for the bugs they’ll encounter here.

In the Annapurna Sanctuary

The final issue is altitude sickness. The typical schedules offered by the guidebooks and the itineraries followed by the trekking companies give plenty of time to acclimate to the high elevations. If you’re trekking on your own, don’t try to rush this part: The elevations are frankly dangerous, and to be safe, you’ve got to follow the rules.

A final alternative is to extend the 19 – 21 day circuit with another week of trekking into the Annapurna Sanctuary itself. This takes you to the all-white world of the mountaineer, and you can stay overnight at Annapurna Base Camp. If you’re coming all this way, it is absolutely worth the additional time.

Nepal is not an easy destination: The entirely different culture, the hygienic problems, the sometimes limited food choices, the Sanskrit alphabet, the unfamiliar religious customs which foreigners should respect but may not understand…. all of this leads to a feeling of what the French call depayse: being out of one’s element. But the dramatic beauty of the highest mountains of earth is worth every possible traveler’s travail. Among the highlights were the views of 7,000 and 8,000 meter peaks, the climb to nearly 18,000 feet, the stark whiteness to the Annapurna Sanctuary, the emerald green of the rice fields, the rhododendron forests in bloom, the sky-piercing point of Machapuchare, and the sheer power of the raging rivers that drain the snowmelt and the remnants of avalanches. All of which, added together, put this trek securely among the top hikes in the world.