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Trekking to Everest Base Camp: Part I

This is a three part series about Linda Sanders’ trek to the Everest base camp, and is accompanied by an interview about the journey. See Part I of the interview here:


The Plan and The Preparation

During my second year of residency I was searching for a very different elective experience that would expose me to extreme environments and associated illnesses. After months of research and preparation, at the end of March 2015 I embarked on a unique elective experience with a group sponsored by the Wilderness Medical Society (WMS) to trek to Mount Everest Base Camp (E.B.C). For me, a trek to E.B.C was an opportunity to enjoy the beauty of the Himalayas while gaining first hand experience at extreme altitude. I was hoping to gain exposure to the challenges of maintaining one’s own health and treating disease in an austere, resource limited environment. I can now say that I did in fact get some first-hand experience with altitude illness, perhaps more personally than I would have liked, but the experience was absolutely worthwhile. The beautiful and monstrous mountains are unbelievable. And I am now in awe of the strength and the kindness of the Nepalese people, and the courageous medical teams caring for the locals and visitors to the Khumbu region of Nepal from those at Base Camp to the few small hospitals in local villages along the way that are perched anywhere between 10,000 to 17,598 feet.

The trek is an annual trip for the WMS with associated daily lectures surrounding international and wilderness medicine topics. Thanks to our month long combined elective and vacation month at Temple, I arranged a few extra shift swaps and I was all set to go across the world to Kathmandu.

Nepal is one of the top twenty poorest countries in the world, surrounded by the highest mountains on Earth, formed by the ancient collision of two land masses, India and Asia. These masses are still colliding today, and have lead to the tremendous tragedy this past April with the Earthquake in Nepal and the second earthquake on May 12th. There exist only fourteen 8000 meter (>26,000 ft) peaks in the world, and six of them are in Nepal. So even if you are not summiting a peak in the Himalayas you’ll still be walking among the highest places on Earth.

Preparation

So much of achieving one’s goal on a major trek such as this one is preparation in order to keep oneself and your fellow trekkers healthy and safe. Before I left for Nepal I carefully considering the best options for clothing, water sanitation, and medications to treat the most likely ailments I would encounter on the trek.

For two months prior to my departure I gathered supplies – some of which I had from previous trips. These included medications, vaccinations, a daypack, water resistant duffel bag, a 0 degree Celsius sleeping bag, trekking poles, glacier glasses (specially designed for wrap around protection at altitude), and layered clothing for every type of exposure because there’s nowhere to hide from bad weather. There was gortex for rain, down jackets for cold weather, layered trekking socks, multiple layers of pants, and “clean” sleeping clothes (a relative term). My own first aid kit included triple antibiotic ointment, Dermabond, suture, a Sam splint, gauze and ace bandages, blister kits (moleskin, glacier gel) and medications including Ibuprofen, Zofran, Ciprofloxacin, Imodium, Nifedipine , Diamox, and Decadron. I’m surprised to say I actually used everything except for the Ciprofloxacin and Imodium.

And perhaps most importantly I bought trip insurance because there was a very real possibility that I would require helicopter evacuation at these altitudes. It’s important to keep in mind that I had never been above 8,000 feet before this trip. Needless to say, I had some anxiety about reaching 18,000 feet.

The Trek

We started our trek from Lukla airport, which is considered the most dangerous airport in the world due to its short runway of only 1729 ft and its high frequency of deadly accidents happening every few years. From 9,000 feet in Lukla our trek would take us forty miles to 18,000 feet in nine days with built in time for acclimatization (two rest days), and then another, albeit quicker forty miles back down in only three days. Most days averaged to about five hours of trekking. When trekking to altitudes above 8,000 feet, acclimatization days are particularly important as it takes time for your body to adjust to hypoxia. Unfortunately in the face of bad weather or other setbacks some trekkers skip acclimatization days putting themselves at increased risk of developing altitude illness. Every trekker wants to achieve his or her goals, but as we would learn from these mountains, it is safest to cut out days on the descent rather than the ascent.

Water Sterilization

The first challenge that I encountered when arriving in Nepal was remembering to sterilize my water. However, this quickly became a daily ritual. Every morning I grabbed two 1L Nalgenes, filled them with bucketed water from the teahouse and immediately sterilized them.

It’s generally safest to use two methods for water sterilization to prevent diarrheal illness both during the trek and when you return home. There are a number of options for sterilization systems. Generally I found a SteriPEN, which uses UV radiation to be the most convenient. It’s small, easy to carry and fast (90 seconds) and thus probably your best option. The major pitfall to this method is the use of batteries. Batteries are hard to find in remote areas and they don’t do well in the cold. A fellow trekker coined the phrase, “Batteries aren’t dead until they’re warm and dead. Like people.” Fortunately I found out that this could be easily remedied by sleeping with your batteries close to you in your sleeping bag. The SteriPEN’s use is also somewhat limited with particulate matter, which forms a shield for pathogens. Thus I examined the water first and in instances where there was a high number of gross particulates I would use a filtration system with a manual pump prior to the SteriPEN.

Filters alone are not an option. While they are great for protozoa, bacteria and helminthes, they do not eliminate viruses. Thus, a second method such as the SteriPEN is necessary. Other options include chlorine or iodine tablets. I did try using chlorine tablets, but I have to say the inconvenience of this method is a problem. There is up to a four hour wait time before the water is considered safe to drink, which means you either have to sterilize your water overnight or be without water for most of that day’s hike. And of course, after four hours your water tastes like chlorine. The bad taste can be ameliorated with Vitamin C tablets.

Either way, as I was to learn, a single mishap whether it be brushing your teeth with tap water or drinking unsterile water can quickly, or sometimes slowly result in an unpleasant outcome for the traveller.

PART TWO

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