28 March-3 April 2014 #700

Too high, too fast

Dhanvantari by Buddha Basnyat, MD

Around the end of February this year a tragic story unfolded near the pass at Thorong La (5,400m) that will sadly happen again if the awareness of altitude sickness is not highlighted for a new generation of Nepali trekkers. Seven young Nepalis from Birganj went trekking around the Annapurna Circuit as a class reunion. Near the Pass, they were caught in a blizzard and one of them died, probably due to severe altitude sickness, while others suffered from extreme hypothermia and frostbite. Deaths from altitude sickness and hypothermia are almost always a 100 per cent preventable, which is why it is all the more tragic when someone young dies from it.  

With a motorable road now connecting Beshisahar (200m) in Lamjung to Chame (2,900m) in Manang, an increasing number of Nepalis, many of them ill prepared for altitude, are hiking the Annapurna circuit. Unlike many tourists Nepalis approach high altitude travel in a more cavalier fashion, most will not have read up on altitude sickness, hypothermia, and preparation for different weather conditions.  And then when tragedy strikes there is a “ke garne” or “lau ja” response, a typically fatalistic attitude that pervades our daily lives.

Many young Nepali trekkers arrive by jeep to Chame in Manang from where they keep ascending by riding hired motorbikes to Manang at 3,500m and within four days of leaving Kathmandu or the plains, they attempt to go over Thorong La. This incredibly fast rate of ascent at altitude is clearly a strong risk factor for altitude sickness as it does not give the body enough time to acclimatise.

We do not know the travel schedule or the ascent profile (how fast did they gain altitude?) or other details about the group of seven young Nepalis, and we sincerely hope that those undergoing treatment recover promptly. But attempting a 5,500m pass in four days from Kathmandu is dangerous for anyone, even for the Sherpas. It has also been reported that many Nepali trekkers are in a celebratory mood and drink alcohol just before the pass. Many lodge-owners along the terrain apparently prefer Nepalis to western tourists because the Nepalis rack up a huge ‘booze bill’.

If altitude sickness is classically described as a ‘hangover’ (even without drinking alcohol) imagine then the effects of excessive alcohol drinking when you already may have symptoms of altitude sickness because of rapid ascent. Alcohol has another detrimental effect at altitude: it causes people to breathe less (hypoventilation).

Hyperventilation (breathing more without knowing it) is the opposite of hypoventilation, is the cornerstone of acclimatisation at high altitude. So, anything that puts the brake on ventilation is potentially harmful and counterproductive for acclimatisation.

Such knowledge is lacking amongst many young Nepalis climing to high altitudes. A pdf file about travel to high altitude which Dr Maniraj Neupane of the Mountain Medicine Society of Nepal painstakingly translated into Nepali is freely available and very helpful. 

International Society of Mountain Medicine (ISMM)


Mountain Medicine Society of Nepal (MMSN)


Himalayan Rescue


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