Everest Clinic Tends Ills on High

Emily Huhn
National Geographic Adventure
April 4, 2003
The world's highest medical clinic opened on April 1 at Mount Everest Base Camp, just as climbers began to arrive to mark the 50th anniversary of the first ascent. Located at 17,500 feet (5,330 meters), the tent-based clinic will be run by a member of the Himalayan Rescue Association (HRA), Luanne Freer, and staffed by volunteer physicians who will treat visiting trekkers, climbers, and Base Camp staff for ailments such as high altitude sickness, frost bite, and snow blindness.

The mission of the HRA, which opened its first clinic in 1973 in the Khumbu village of Pheriche, Nepal, is to reduce casualties due to high-altitude sickness in the Himalaya and to provide low-cost medical care for the Nepali people. Funded by donations and fees generated from Western trekkers, the Everest Base Camp Medical Clinic is the HRA's most recent endeavor. The idea to start a central, organized clinic on Mount Everest originated when Freer, a 45-year-old emergency medical physician, visited Base Camp last year and saw the need for more medical care on the mountain. This year, the clinic will operate from April until climbing permits expire in May, with two board-certified physicians and medical students on site. Before Freer traveled to Nepal to prepare for the April 1 opening, we spoke with her about the state of health care at the top of the world.

How did you become interested in high-altitude medicine?

During medical school on the East Coast, I spent nearly every vacation in the Rockies. On one trip I saw hospital signs in Yellowstone—I couldn't believe you could work in a hospital in a national park. So in 1992, 12 hours after graduation, I literally drove out to Yellowstone to work.

Even at 8,000 feet [2,440 meters], 25 percent of my patients developed some form of altitude sickness, so I started doing an epidemiology study. The more I asked about the subject the more I wanted to know, and I've worked there every summer since. I'm now the park's director of medical care.

How did you become involved in the Himalayan Rescue Association?

I ended up making an impromptu decision to join a group of physicians trekking in Nepal in 1999. While there, I volunteered at a clinic where we treated about 650 Sherpas in five days. This was my first introduction to the needs of the area, and I couldn't wait to get back.

The mission of the HRA is to prevent serious altitude sickness and reduce casualties due to altitude sickness in the Himalaya. What upsets us most is that death from altitude sickness is almost always preventable, so we strive to offer education as well as medical care to visitors and locals.

Why did you want to start a clinic at Base Camp?

When I visited Base Camp last year, I met some expeditions who brought their own physicians, and others who didn't. A light bulb turned on when I discovered that the teams without doctors were trying to wing it and practice medicine without any training. Expedition leaders are basically well-versed with treatment of high-altitude sickness—they see it more often then most physicians—but they have trouble with common ailments like bronchitis and diarrhea. So I thought, Why not set up one clinic that has physicians with altitude training and experience with common local problems, and improve care and reduce expedition costs?

How will the clinic operate?

The staff are all volunteers [except our paid Nepali interpreter]. I will be on staff throughout the climbing season, and there will be two board-certified physicians present at all times. There will also be a resident in emergency medicine and a medical student conducting altitude research and helping out with clinical care. We'll be recruiting volunteers at lower altitude and putting them on medication designed to prevent altitude sickness. Our staff will maintain contact with them during the trek, monitoring their symptoms and the effects of the medication.

We have everything from pulse oximeters [devices that measure the oxygen content of blood] to eye drops to splints for leg fractures to a hyperbaric chamber [a sealed enclosure that simulates descent by increasing the air pressure inside]. Plus basic medications like anti-nausea medication and intravenous fluids. There will be two cots available, but anyone with a serious illness or injury will be stabilized and evacuated to lower altitude, where they will invariably recover faster.

What types of illnesses do you expect to see?

The most common ailments I saw last year were gastrointestinal—vomiting, diarrhea. It's challenging for physicians to sort out the cause of gastrointestinal illness, because it can be any number of things—viral, food-borne, amoebic, bacterial. I work to update myself and my staff on the latest emerging pathogens. We also plan to see more severe cases of altitude sickness, including high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE).

Does human waste present a serious health hazard on Mount Everest?

The ministry of tourism in Nepal has done a good job of regulating human waste at Base Camp. Climbing teams have to pay for permits for a latrine or disposal system, and all waste has to be portered out. I can't say that waste doesn't contribute to health concerns at all, but they are making every effort to control it.

Can you describe a medical case from your previous experience in Nepal?

Treatment can be really gratifying with high-altitude medicine. Rarely do you get to see people so close to death, then see such dramatic improvement just a few hours later. Once a German trekker stumbled into the Pheriche clinic on the shoulders of his Sherpa guide. He was delirious, had blue lips, and was gasping for breath, unable even to dress himself. He suffered from HAPE and HACE. Although there was a three-way language barrier (German-Nepali-English), we were able to save his life and he recovered within 12 hours. Another instance that comes to mind occurred when I wasn't even at my clinic. A Nepali porter was found unconscious on the trail and was brought in at night to the Pheriche clinic barely breathing and suffering from hypothermia, HACE, and HAPE. My translator, Gobi, who was 26 at the time and had no formal medical training, was familiar with altitude treatment after working so closely with doctors. Luckily, Gobi and our Sherpa aide, Namkha, warmed up the patient and gave him appropriate medication. By the time I got to the clinic, the patient had woken up and recovered— in fact, he decided to walk down the mountain on his own, against our staff's advice.

Who is most susceptible to high-altitude sickness?

If someone lives at altitude they tend to have more red blood cells to carry oxygen. Most of the indigenous people have some genetic abilities to deal with acute altitude exposure. Still, a misconception exists among the Nepali that they can't get sick from altitude, so they don't see themselves as susceptible. Last year I saw as many Sherpas as Westerners with altitude sickness. Sherpas get paid by the load, so they often push themselves harder and carry heavy loads up the mountain, which puts them at higher risk for developing pulmonary edema, or fluid buildup in the lungs. So a Sherpa gets the same advice and treatment from us as does a trekker from Los Angeles: Go slowly, rest often, and stay well hydrated. If you do become sick, rest, and if you don't improve, descend!

How do you envision the clinic evolving?

Ideally we would like this clinic to become a recurring, reliable fixture every spring at Base Camp. Our goal this year is to break even and cover the clinic's costs. Right now patients will be charged for supplies and medications. For Nepali people, including Sherpas, we only charge a 100 rupee administrative fee, about 75 [U.S.] cents. If we can make a profit, that money will go toward equipment purchases and to support the other clinics that offer free care for Nepali people.

I would love to have our clinic grow and be a sort of flagship for other clinics at high altitude. We take so much from the people and the environment of this region, I feel that with my level of training this is one way I can give back.

More Mount Everest Stories From National Geographic News:
Everest Time Line: 80 Years of Triumph and Tragedy
Making Movies on the Roof of the World
Everest Snowboarder Vanishes On Second Try
Altitude a Major Challenge to Climbers
The Sherpas of Mount Everest
Everest Melting? High Signs of Climate Change
Everest Anniversary Expedition Wrap-Up
National Geographic 50th Anniversary Everest Expedition Reaches Summit
Everest Anniversary Team Makes Final Summit Attempt
Jet-Stream Winds Trap Climbers on Everest
Sons of Mount Everest Pioneers to Repeat Historic Climb

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