You’ve gone to Nepal twice now to provide healthcare during climbing season. Where were you stationed and what are some of the unique challenges you face as a medical professional working in such remote conditions?
This last March through May, I was working primarily at the Himalayan Rescue Association clinic in the town of Pheriche, which is nestled in the Khumbu Valley. The Khumbu is renowned for its stunning natural beauty and its proximity to some of the world’s highest peaks, including Mount Everest, and the Everest Base Camp is only a one- to two-day hike away. Pheriche itself sits at an altitude of approximately 14,200 feet, which makes it a common location where people start to experience altitude-related illnesses. The town is a transportation hub for supplies being brought to Everest and is a critical stop for porters, trekkers and climbers on their way to Everest Base Camp. It plays a vital role in providing medical care to both international visitors, and more importantly, local Nepali porters who support these expeditions.
Working in a location such as Pheriche presents numerous challenges due to its remote location and harsh environmental conditions. The high altitude and cold temperatures are constant stressors, as they can exacerbate health issues and limit the types of medical interventions available. The clinic relies on solar power, which means that electricity is not always guaranteed, especially during cloudy or snowy periods, which can appear at a moment’s notice. Any electrical equipment assisting with diagnosis or treatment may suddenly not be available, as well as communication equipment such as radios or internet connections. Running water is another scarcity, making basic hygiene practices that we typically take for granted in our well-resourced hospitals much more difficult to maintain. There are no roads in the region, and all supplies must be carried in by a porter or yak.
What kinds of healthcare can be provided near Everest Base Camp? What’s the setup for those who have never been?
Due to the remote location and lack of utilities, resources are quite limited at Everest Base Camp. There are no roads connecting the towns along the 35-mile and 8,500-foot ascent to the camp, so all supplies must be physically carried by porters, yaks or, in special cases, helicopters. This logistical challenge makes it difficult to maintain a steady supply of medical supplies and general provisions, as well as assist patients who require evacuation to lower altitude. Despite these limitations, the local people have demonstrated remarkable resourcefulness, developing unique solutions to the challenges posed by their environment. There are no permanent buildings or solar panels, as it is on a glacier that is constantly moving. While bottled oxygen is available in the tent-based emergency room, it is reserved for the most critically ill patients. The limited electricity generation at Base Camp cannot support an oxygen concentrator, making long-term oxygen therapy impractical. Basic diagnostic equipment like ultrasound is available, but the high altitude and scarcity of resources necessitate the evacuation of ill patients to lower elevations for definitive medical care.
In addition to providing general care, you were also conducting research on new innovative ways to combat altitude sickness. Can you briefly discuss that and the results?
Diamox was discovered in the 1960s to prevent acute mountain sickness (AMS) and alleviate many of its associated symptoms. Since then, other medications such as dexamethasone and ibuprofen have also been found effective in managing AMS. While supplemental oxygen from tanks or portable oxygen concentrators can relieve altitude symptoms, these solutions are often impractical in mountainous regions due to their size, cost and electricity requirements. So, medications are typically the only resource available for physicians to treat this condition.
CPAP (continuous positive airway pressure) machines, typically used for sleep apnea, have potential to treat AMS. By increasing airway pressure, CPAP machines help expand the alveolar sacs in the lungs and increase pressure of gas across the alveolar walls, enhancing oxygen absorption into the bloodstream. This improvement occurs even though the concentration of inhaled oxygen remains unchanged. The resulting increase in blood oxygen levels has the potential to resolve AMS symptoms effectively. These devices have become quite small, around the size of a soda can, and can be battery powered. This overcomes many of the limitations associated with providing supplemental oxygen. Early results from my study using CPAP to treat AMS in the Mount Everest region have been promising, with most patients experiencing rapid symptom relief when using CPAP devices. However, further research is needed to establish an optimal treatment protocol for high altitude, especially when used outside of a traditional healthcare facility.
Why is it so important to discover new potential treatments for altitude sickness in places like the Himalayas?
The Himalayas, along with other remote high-altitude settings, are ideal for altitude research because these regions urgently need innovative solutions to a rapidly growing problem. Unlike the Rockies, popular destinations in the Himalayas are also incredibly remote, with no straightforward transportation options to lower elevations. The economic disadvantage of these regions means that the people most severely affected by altitude-related illnesses cannot afford the necessary helicopter transportation, which is increasingly available to more affluent travelers. Developing low-cost and novel treatments that are accessible to these patients can significantly improve their health outcomes. By focusing research efforts in these areas, scientists and medical professionals can create solutions that are practical and life-saving for those who live or travel there.
What was the most interesting observation you made during this climbing season at Everest?
High altitude pulmonary edema (HAPE) is a rare but serious condition where lung tissues swell and fill with fluid in response to rapid elevation increases. This condition most commonly affects hikers and porters on the Everest Base Camp trek, as well as mountain climbers at higher elevations due to quick ascents. Over the past two years, the number of HAPE cases has dramatically increased when compared to previous years, more than doubling in number over this time. The reasons for this surge are unclear, but some possible factors include more trekkers and porters neglecting acclimatization protocols, or the impact of respiratory infections such as COVID.
Another notable observation is the large and cumbersome loads carried by many porters along the trail. Porters are typically paid by weight to transport items to and from Everest Base Camp, incentivizing them to carry as much as possible as quickly as possible. Some porters carry loads as heavy as 200 pounds at high elevations. An incredible feat but one that puts them at high risk of altitude-related illnesses and orthopedic injuries. This situation exacerbates the economic stressors they face, as their health risks increase with the weight they carry.
Why are the Sherpas so good at carrying things at these altitudes? Have their bodies adapted to the altitude?
The reasons behind the ethnic Sherpa group's exceptional performance at high altitudes remain largely a mystery, though recent investigations have revealed intriguing genetic adaptations. Over many generations living at very high elevations, around 14,000 feet, the Sherpa population has accumulated various genetic modifications that enhance their ability to utilize oxygen for metabolism, especially at altitude. Similar genetic adaptations are observed in other parts of the world where certain ethnic groups have lived at high altitudes for extended periods. While the superior physical performance of the Sherpa people at high altitudes is evident, much remains to be understood about the underlying mechanisms behind this.
What’s next for you? Are you going back to Nepal?
I am hopeful that I will return to Nepal soon to work with the Himalayan Rescue Association once again. In the meantime, I plan to continue research into CPAP and other technologies’ effect on providing healthcare settings here in Colorado with civilian and potentially military populations. My goal is to return to Nepal to work specifically at the Everest ER, the medical tent located within Everest Base Camp itself. I also hope to adapt some of my existing work to designing and improving healthcare infrastructure for spaceflight, another care environment which bears significant resemblance to the high altitude and remote settings where I’ve previously worked.
