A fascinating write up of life at a remote healthpost in Nepal

Visit to Deusa Healthpost, Solukhumbu (March 2009) 

Trekkers overlooking view from Gokyo Rei over Ngozumpa Glacier & Cholatse Range, Everest Region, Nepal

My name is Alina, and I am a medical student from the UK.  In February, with my boyfriend Euan, a nurse in A&E, we walked to the village of Deusa in the Everest region of Nepal.  We were away for just over 6 weeks. Having walked for 4 days from the nearest road, 4 incredible but very long days of going up mountains, then down to rivers, then up and down again, the village we stayed in was extremely remote.  Although most homes have a radio and a few have one light at night powered by a solar battery, there is practically no infrastructure as we know it, and life is very different to back home.  It was an amazing experience, both culturally and medically. We went to this village, Deusa, to help out at the health post.  There is already a midwife there, whose wages are paid for by a doctor in the UK.  As we found out, Deusa is very lucky to have a nurse that is qualified and actually turns up each day.  She works there 6 days a week, and is the nearest port of call for 6000 people.  The nearest hospital is a 6 hour walk away.

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Mike Grocott Expedition and Wilderness Medicine lecturer speaks to the BBC about the Caudwell Extreme Everest Expedition

Everest trip helps critically ill

Copyright  Michelle Roberts
BBC News health reporter

Dr Grocott and the Caudwell team plan another trek in 2009

The lessons learned by medics from a trip to Everest could help the treatment of critically ill patients.

The team that braved the Himalayan summit to study the body’s responses to extreme adversity has recorded the lowest ever human blood oxygen level.

The results could see treatment plans for some patients with similarly low blood oxygen levels re-evaluated.

The “Caudwell Xtreme Everest” work has been published in the New England Journal of Medicine.

The blood readings established what has long been suspected – that high-altitude climbers have incredibly low levels of oxygen in their blood, which at sea-level would only be seen in patients close to death.

The figures they have got are quite incredible. They are phenomenally low oxygen levels Anaesthetist Dr Andy Tomlinson

The average arterial oxygen level was 3.28 kilopascals or kPa – the lowest was 2.55 kPa.

The normal value in humans is 12-14 kPa and patients with a level below 8 kPa are considered critically ill.

Expedition leader Dr Mike Grocott said: “We rarely see below 6 kPa in our patients.

“Yet our readings were well below this and we were walking and talking and functioning normally.

“This gives us some perspective about what levels of oxygen deprivation people can tolerate.”

He said some critically ill patients may have adapted to the low oxygen levels and may not need the aggressive interventions, such as ventilation, that are currently given to get blood oxygen levels closer to normal ranges.

“All these interventions carry a risk of harm and you have to weigh up the benefits versus potential damage to organs like the lungs.

“Maybe we could be less aggressive in treating some of these patients.”

He said other intensive care researchers were planning to investigate it.

Tolerance limits

Acting as guinea pigs themselves, the London team of medics – five anaesthetists, two GPs and a vascular surgeon – took the first readings of human blood oxygen 8,400m above sea level.

The team climbed with oxygen tanks, then removed their masks 20 minutes prior to testing to give time for their lungs to get used to the low-oxygen atmosphere and to avoid any skewing of the readings.

The team were unable to make the measurement on the summit of Everest as conditions were too severe, with temperatures at -25C and winds above 20 knots.

Having descended a short distance from the summit, the doctors removed their gloves, unzipped their down suits and drew blood from the femoral artery in the groin.

The samples were then carried by Sherpas back down the mountain and analysed within two hours at a science lab set up at the team’s camp at 6,400m.

Based on calculations of the expected level of oxygen in the blood, the Caudwell Xtreme team speculate that accumulation of fluid in the lungs as a result of the high altitude might have contributed to the low oxygen levels.

They hope ongoing research will eventually lead to better treatments for patients with acute respiratory distress syndrome, cystic fibrosis, emphysema, septic shock, “blue baby” syndrome and other critical illnesses.

Dr Andy Tomlinson, an anaesthetist at the City General Hospital in Stoke-on-Trent and a keen climber, said: “The figures they have got are quite incredible. They are phenomenally low oxygen levels.

“There is obviously a difference between critically ill patients and fit and healthy climbers.

“Never the less, there are lessons to be learned for critical care.”

Dr Peter Nightingale of the Royal College of Anaesthetists said: “This may well make doctors re-evaluate their current provision of oxygen and the researchers may well be right that patients can run on lower oxygen levels.

“But we do not know and we need more research.”

Mike Grocott is a Expedition and Wilderness Medicine lecturer and presents on our UK training course – Expedition and Wilderness Medicine UK

Medicine in the Himalayas – Dr Kirstie Nicol

Working for the Himalayan Rescue Association in Nepal

About the writer.  Dr Kirstie Nichol is a G.P. with a keen interest in expeditions and the medical issues or remote locations.   She has attended the Expedition and Wilderness Medicine course in Keswick and the Polar Medicine training course in Alta, Northern Norway and worked as an expedition medic for Across the Divide Expeditions in locations as diverse as Kilimanjaro and Peru.

In 2007 I left ‘normal’ working life as a GP in Haddington behind for a while to work for the Himalayan Rescue Association in a high altitude clinic in Nepal.

The HRA is a Nepalese voluntary non-profit organisation formed in 1973 with an objective to reduce casualties in the Nepal Himalayas, especially in view of the increasing number of Nepalese and foreigners who trek up into the remote wilderness. Nepal alone now receives more than one hundred thousand trekkers from around the world every year. It can be easy to under-estimate the dangers of altitude illness; deaths from these conditions are all the more tragic because they are entirely preventable. Working at the clinic involves a mix of primary health care for local people including home visits, providing an emergency medical service for trekkers and the provision of daily lectures for trekkers emphasising the prevention, recognition and treatment of altitude illnesses. Because rescue is difficult in Nepal, prevention is a key part of the role.

Mountain Medicine Course

Most of the UK Expedition and Wilderness Medicine Faculty has a background in Mountain Medicine, and like many British expedition medics most of us started climbing in the Alps before moving to the bigger mountains in Nepal. Following the same theme as our other extreme environment courses, the main thrust of the mountain medicine course is to introduce medics to the practical elements of working and providing medical cover in the mountains.

The instructors aim to familiarise the team with the fundamental skills which are essential to treat and evacuate casualties in the mountains as well as covering the common conditions encountered at altitude. Where else could we run this course but in Nepal. In order to experience winter conditions in the mountains the course will be run in the beautiful amphitheatre and ridges of Annapurna with the sacred mountain of Machapuchere as a backdrop. At this time of year the snow cover is low and the team will be able to train and experience the environment without undue exposure to high altitude.

Expedition and Wilderness Medicine is now a unique provider of medical courses in extreme environments and continues to attract fantastic staff and lecturers from around the world.  It’s advisable to put your name down now for this course as we envisage it to be a popular one!  Email Luci at admin@expeditionmedicine.co.uk

‘The faculty in Nepal will be very exciting and experienced. Can’t divulge any names yet but no one will be disappointed’. 

Luanne Freer joins the Expedition Medicine team.

We where privileged at EML to have the Everest Base Camp MD Luanne Freer join our lecture team for the Lake District Expedition Medicine courses during her recent visit to the UK

She has a great website for those of you interested in altitude medicine and the video below illustrates the difficulties of operating at this height

Visit her Everest MD website here

The BBC trailor for the documentary about her.

Mountain Medicine course in Nepal.