On top of the world

After answering a cryptic email asking for fieldwork volunteers, Steve Seale managed to swap the sterile surroundings of a laboratory for the stunning scenery of Nepal

In May 1953, Edmund Hillary and Sherpa Tenzing became the first mountaineers on record to climb to the summit of Mount Everest. Celebrations of the 50th anniversary of this event saw a gathering in London of some of the world's best mountaineers and a record number of climbers attempting to reach the summit. Last September, I was lucky enough to visit the Nepalese base camp, spending time on a research project and working in a small aid post a few kilometres down the valley.

In July 2002, I received a cryptic email forwarded to me as a member of the Wilderness Medical Society: "Eight willing volunteers are needed to take part in a fieldwork project in the Khumbu [Everest] region of Nepal. Outdoor equipment and experience are necessary and language skills would be useful. Aloha. Jeff."

DERMOT TATLOW/PANOS

All aboard the porter express

Mauna Kea to Mount Everest

Jeff turned out to be a final year medical student from Hawaii who--when not surfing--researched altitude sickness by driving people high on to Mauna Kea, the highest volcano on the island of Hawaii. He was organising his second trip to the Khumbu region to look at the prophylactic effect of Gingko biloba the prevention of acute mountain sickness. We would be required to recruit and interview trekkers and mountaineers at various points along the trail up to base camp (hence the language skills) and live at an altitude of 5000 m for a month and a half. With my "conversational French and Spanish"--I once asked for a beer--and having done a fair amount of climbing, I was accepted, as was Joel, a fellow medical student from Oxford. Together we jetted off in mid-September to Kathmandu to meet the rest of the (all American) team.

Our base was in Pheriche, a hamlet at 4000 m, on the main route up to base camp. All the trekkers and mountaineers pass through it--up to 100 a day in the high season--most spending at least two nights to acclimatise. Reachable only by foot or helicopter and inhabited for only part of the year, it was a fairly unwelcoming place; we were greeted by a white out and 30 cm of fresh snow. Our luck changed though and for the rest of the month there were no clouds and beautiful views.

Pheriche or for poorer

Pheriche is the location of a small aid post run by the Himalayan Rescue Association, a Nepalese based organisation that provides medical care for visitors and locals at high altitude. With room for two patients, oxygen concentrators, and basic medical supplies, the post can offer advice and treatment for common complaints and keep people alive while they await evacuation. In recent years Sandy Scott, a British general practitioner, has put great effort into renovating and equipping the Pheriche post, and two doctors are now there every season providing quality (although expensive) care for foreigners and virtually free care for locals. Every day they lecture interested visitors on the problems they face at altitude. Two years ago there were 10 deaths among trekkers in the Everest region, almost all of them preventable.

Although members of the team in Pheriche recruited subjects for the trial, two of us were stationed in Lobuche, a village at 5000 m that is the penultimate stop before base camp. Here, as well as collecting data from those enrolled in the trial, we acted as an extension of the medical care provided by the aid post. During our daily rounds of the guest huts, we would encounter cases of all the forms of altitude sickness--high altitude cerebral oedema, high altitude pulmonary oedema, and acute mountain sickness. On occasions these were serious enough to warrant immediate evacuation--not a decision to be taken lightly. A freezing night-time trek down the mountain for 10 km on rough ground was bad enough, but finding a horse in the dark to take the patient down was almost impossible. More often than not we organised a porter train to evacuate the patient, with one porter taking it in turns to carry the patient on their back while a second porter stabilised the legs. The porters were remarkable given that most of them were lowlanders and prone to altitude sickness themselves.

Down in Pheriche, cases at the clinic were varied. I saw a surprising amount of people with pyschiatric problems. Trekkers may experience panic attacks through worrying about the symptoms they get from being at altitude. Others come to Everest to die--the region apparently attracts troubled souls as well as tourists and climbers.

PAULA BRONSTEIN/GETTY IMAGES

The body of Everest climber and Sherpa guide Karma Gyalzen (aged 28) is cremated in Kathmandu,Nepal. He died collapsing at Camp 2,descending from South ol on the Everest summit attempt

Khumbu cough

Other cases included heartburn, haemorrhoids, and chest pain--I even had to use my rusty electrocardiograph skills to operate the tracer at the post. Injuries related to the weather were common; I saw frost bite, chapped skin, and sunburn. The dry air and fumes from yak dung fires meant that virtually everyone developed a "Khumbu cough," and as most people were also exercising all day becoming dehydrated was easy.

For patients needing evacuation from Pheriche, the choice was between helicopter--which needed insurance--or being carried down by horses or porters. The thin air meant that weight is so critical for the helicopter that most patients cannot take their backpacks with them, and flying any higher than Pheriche is hazardous. It was much better to be carried down with only the yaks to worry about, although you might disagree if face to face with one on a narrow bridge.

Fat Brits with bad teeth

We will soon publish the study. This was my first taste of real fieldwork and I would thoroughly recommend it--we learnt how to set up a decent study, did the fieldwork, and visited an absolutely beautiful region of the world. The clinical experience was fascinating and educational, and we learnt to rely on the bare minimum and our clinical skills. I made some great friends and cannot wait to go back. Jeff later told us that he had invited us to see if all British people were short and fat with bad teeth; I never told him what we thought the Americans would be like.