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Climbing

Jun 14, 2018

Everest ER: Medicine at the Top of the World

With all the stories about people getting injured, and even dying while climbing Everest, it’s not often you hear about the brave souls who protect and care for the climbers.

Organizations like Everest ER make it possible for Everest climbers to scale the mountain safely knowing help will be there should anything go wrong. The Everest Base Camp Medical Clinic is a project of the Himalayan Rescue Association-USA (US based nonprofit charity organization) and Himalayan Rescue Association (a nonprofit Nepali NGO).

Here is their story.

On a chilly evening at 5400 m, as Dawa (Suvash), Subs (Subarna) and Brent (Brenton) are pouring “Su Chiya” (Salty Sherpa Tea) into the cups, the radio suddenly crackles. A Sherpa mountain guide, they had gotten well acquainted with earlier in the season, speaks on the radio, “Everest ER, do you copy?”

Dawa picks up the radio, and responds. There is news of two Sherpas (technically, high altitude workers) who are sick at camp 2 on Everest. As they try and connect with these sick Sherpas via radio, the connection is lost. The team springs into action. Abandoning their still full teacups on the table, all three head out with radios in hand, trying to grab the frail signal moving around the camp.

After ten minutes of trying, they seek help from the base camp crew of an expedition that has a base radio and a medical kit in their tent, at Camp 2. The sick Sherpas are taken into that tent, and via their friend, they receive medical instructions. After confirming that the appropriate medicine has been dispensed, the doctors can finally call it a day, radios purring besides their sleeping bags in their homely tents.

Everest ER

It might not have been pulling someone from the jaws of death, but the three doctors are happy. This is why they came to the mountains, to address problems like these. This incident is an example of many the volunteer doctors of Everest ER deal with on an almost daily basis.

The Everest ER is a seasonal aid post, run every year during the spring climbing season by the Himalayan Rescue Association (HRA) in a tent at 5400m, in the heart of the Everest Base Camp. The HRA is a nonprofit, non-governmental organisation that was established in 1973 and runs two other aid posts targeting trekkers, one at Pheriche in the Khumbu valley and another at Manang in the Annapurna Circuit.

The Everest ER was set up by Dr. Luane Freer in 2003 recognizing the lack of proper medical services for the 1500 or so temporary residents of the Base Camp Tent City. This year marked the 16th consecutive season that the ER has functioned, including the 2014 and 2015 tragedies where it was a major contributor in emergency response and relief efforts.

Everest ER

The Everest ER is manned each year by three doctors, and from 2011 at least one Nepali doctor. The doctors are selected by a panel of doctors forming the medical unit of the HRA, who are themselves experts in altitude medicine. The selected doctors are therefore well experienced in altitude medicine and remote medicine besides having volunteered for a season at either Manang or Pheriche clinic.

As for the Nepali volunteers, having a Diploma in Mountain Medicine is highly preferable. This year marked a few firsts for Everest ER. In its 16 seasons, this was the first season with an all male team of doctors. This year’s team featured Dr. Brenton Systermans, an Emergency Doctor from Geelong, Australia who also works as faculty teaching expedition medicine and polar medicine courses, Dr. Subarna “Subs” Adhikari, an Orthopaedic Surgeon currently working in Pokhara (Nepal) and Dr. Suvash “Dawa” Dawadi, a General Practioner from Kathmandu.

This was also the first season when there were two Nepali doctors (both with the Nepalese Diploma in Mountain Medicine and prior altitude medicine experience of some variety). Besides the doctors, there is a fourth wheel to the Everest ER, the ever present Mr. Lakpa Norbu Sherpa, in his 16th season with the ER, who is one of the few long-line rescue trained personnel in Nepal.

Everest ER

The ER functions through the spring climbing season which usually lasts for 2 months from April to May. Being the only medical facility north of Pheriche (a 4-5 hour walk from Base Camp), the Everest ER is your friend in need.

From a nagging cough to dangerous pneumonia, from a bothersome diarrhea to life threatening altitude sickness, not to forget the limb threatening frostbite to life threatening trauma and falls; this is usually your first stop for treatment. Despite being housed in a temporary structure on a glacier that is continuously shifting shape, Everest ER is relatively well stocked in terms of medications and equipment.

The medications get restocked by helicopter ferries, and the equipment ranges from pulse oximeter to a portable ultrasound machine (donated for a season this year by the manufacturing company). The climbers paying for consultations and medicines are also contributing in their own way, as this allows the clinic to subsidize care for the Sherpas and support staffs whereby they get cheaper treatment than at a hospital in Kathmandu, the capital city.

This “Robin Hood” model is to encourage better health-care, seeking practices among the support staff so that they do not hide illnesses and medical conditions for the fear to having to spend too much, or worse still for the fear of having to end their expedition, losing most often the only chance of an income for the year.

Everest ER

The 2018 season saw 397 patients receive care from Everest ER; almost ninety percent of the patients were male and sixty percent were Nepalese (Sherpa). The most common reason for visit was upper respiratory tract infection followed by high altitude cough (Khumbu Cough).

The clinic managed 19 cases of frostbite and sanctioned 42 helicopter evacuations from Base Camp to Kathmandu, out of which, 14 cases were evacuations from Camp 2. One particular example, where the right sequence of actions by a series of different people saved a life, was that of a Sherpa who was hit by an object (according to a climber who first got to the injured man, an oxygen bottle) on his head that cracked him open.

A random climber passing by provided him primary care, and radioed in on the HRA frequency about the injury. Captain Maurizio Follini (with Kaliash Helicopter Services) and rescue-trained Lakpa of Everest ER took immediate action, rescuing the stricken Sherpa from Camp 2 within 30 minutes of first radio, without worrying about who will pay for the rescue (his insurance status was unknown). As he was brought down to the Base Camp still bleeding from a gash on his skull, his ears and nose, it was clear he would need to go to Kathmandu for a scan.

The ER team once again, were lending their hand, controlling bleeding inside the helicopter, as Captain Maurizio just rested the helicopter for a while. Seeing his condition, Dawa decided to accompany him to Lukla. With the weather closing in they barely made it.

The Sherpa got transferred to Kathmandu the next day, and was discharged from a hospital there in 2 days, a life saved.

Everest ER

Besides the obvious medical care, the ER team also get involved in training basic medical care, frostbite, skin care and trauma management exercise for mountain guides and high altitude workers at Base Camp.

It is satisfying to be able to share mountain-relevant life-saving knowledge and skills, with people who spend an enormous amount of their time up there. There is a potential to continue this trend and broaden the scope of this education and training program to the climbing Sherpas and supporting staff. For all these moments filled with positivity and optimism, there are also a few moments to the contrary.

The death of an “unsupported” Russian climber, just a hundred meters out of camp 3, where he was left for dead through the night in freezing subzero temperatures above 7000m was heart wrenching. Even more difficult, was hearing updates over the radio from several people passing this person, realising he needed help, but no one taking responsibility.

At moments like this, one feels the helplessness of not being able to fly up, and pull him into a tent, or better still get him off the mountain, maybe he could be saved.

Everest ER

For a medic, Everest ER is an extraordinarily humbling learning experience. The firsthand experience of practicing medicine in an austere setting, generally shapes personalities as a doctor in the future. What one does as a doctor in the city, is entirely different from what one can do in the remote clinic.

In a resource-limited setting, one must make do of whatever little one has. On the other hand, where there are no alternative medical facilities, everything the wilderness doctor does in their capacity, is significant for the patient. Simple interventions can make the difference between giving up an expedition and carrying on, and this is a huge difference. A climber who has spent years in planning and preparing for an expedition has his dreams, aspirations and devotions centered upon his success.

They deserve a chance at success; and treating their upper respiratory tract infection to enable them to reach the summit and to come back to you with a smile can be just as gratifying as getting a person to walk after a hip replacement.

A Sherpa achu (big brother in Sherpa dialect) who relies on his blessed genetic make-up, enormous strength and nonchalant endurance for his entire year’s income, in one climbing season would hold your hands and thank you for curing a sore on his back with simple analgesics and manipulations.

This feeling is priceless and is akin to the divine happiness everyone seeks. It can be a daunting task to keep up the legacy of a clinic that was set up with pure intentions of welfare of the climbers but more importantly, the Sherpas and supporting staff. One spends their entire free time with their ears fixated on the radios, following almost every way of the mighty climbers up the mountains, rejoicing in their success and saddened by their failures.

Observing and living the life of some of the hardest-working and craziest people in the planet is an important, if not the most interesting, aspect of Everest ER. Getting to hear about the legends of mountaineering from people who have closely worked with them is another perk. It is sometimes spiced with the lifetime opportunities of meeting the legends themselves.

The least one can take home from spending a month in the Everest region, is unquestioned awe and admiration, for the wonderful people of the Khumbu and those all over the world who they help to climb the mountains, and those who make it their dream to climb them.

Everest ER

This is just a tiny bit from my experience of spending two amazing months at the Everest ER, as a volunteer doctor. Life has never been so rewarding. As Everest ER survives on donations and contributions, I plead upon the reader to take some time to visit www.everester.org to help this amazing cause.

Having said that, if you happen to be at the Everest Base Camp (South) in April or May, do make that 30-minute hike from Trekker’s Rock (the turning point for trekkers headed to Base Camp) to the Everest ER (HRA) tent and see for yourself.

 

Dr. Suvash “Dawa” Dawadi is a General Practice and Emergency Medicine doctor from Nepal, currently working at CIWEC hospital. He has also earned his diploma in mountain medicine, making him an expert in high altitude medicine and mountain rescue, and is an active member of the Mountain Medicine Society of Nepal (MMSN).

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Events

Jul 10, 2018

The 2018 Whitewater Awards: Nouria Newman and Benny Marr take the spoils.

The Whitewater Awards is a gathering of the world’s best kayakers to show off the biggest and best things that have happened in the sport over the past year.

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WRITTEN BY

Brooke Hess

 To be considered for an award, athletes, photographers, and filmmakers submit media taken over the past year that they believe showcases the best progression in the sport.  

There are sixteen different categories for submission, including separate male and female categories within the “Best of” kayaking categories. Categories include Photographer of the Year, Film of the Year, Expedition of the Year, Best Trick, Best Line, River Stewardship, Grom of the Year, Rider of the Year, along with several others.  Awards are decided upon by a voting process done by the Association of Whitewater Professionals.

This year’s Whitewater Awards was held in the Egyptian Theater in downtown Boise, Idaho. It was hosted on June 14th, the same weekend as the North Fork Championships, which takes place on the North Fork of the Payette River just outside of Boise.  The North Fork Championship is regarded as one of the hardest kayaking races in the world.

The race takes place on Jacob’s Ladder rapid, which is a rapid so difficult and consequential that most kayakers feel accomplished simply by surviving the rapid, much less racing the rapid. Nouria Newman, a 3-time NFC racer and winner of this year’s Whitewater Awards Female Rider of the Year describes it well,

“The NFC is the hardest race in whitewater kayaking. [Jacob’s Ladder] is a scary, consequential rapid. Running it is challenging, and it only gets harder to race it and make the gates.”

In order to minimize the risk involved in the race, event organizers have developed a strict qualification process for racers. 30 racers will qualify to race Jacob’s Ladder. Ten of them are pre-qualified from placing top ten at the event the year before. Those ten then read numerous athlete applications and vote on the next ten racers who will join them.  The last ten racers are decided through a qualification race on S-Turn rapid, another one of the North Fork’s infamous class V rapids.

Every year on this same weekend in June, kayakers, photographers, and filmmakers from around the world flock to Idaho to celebrate quality whitewater, progression of the sport, and the community that surrounds it. Both the North Fork Championship and the Whitewater Awards had great turnouts of athletes and spectators this year.

John Webster

The finalists of each category in the Whitewater Awards were presented in film format at the Egyptian Theater for the entire audience to view, with the winner being announced live. Winners were presented with an award and expected to give a short speech at the event. The big winners of the night were Nouria Newman and Benny Marr, who were awarded with Line of the Year and Rider of the Year in the female and male categories. Nouria says that voting for the “best” in each category is a challenging process, “…voting is always tricky, (look at both French and U.S. presidents, not too sure if they are really the best available option). And it is also very hard to compare lines and rapids. What’s bigger? What’s harder? I got voted Best Line of the Year with a good line down Parque Jurassic, a long technical rapid, but Rata’s line down Graceland, which is a huge slide, was equally as good, if not better.”

No matter how tricky the voting process can be, Nouria agrees that the Whitewater Awards plays a large role in the progression of the sport, “I think it’s super cool to see what people can do in their kayak, how they push the limit of the sport and how they open new possibilities.”

For more information about the Whitewater Awards, you can visit whitewaterawards.com, you can also follow them on Facebook and on Instagram.

You can follow Nouria on Facebook, Instagram and Twitter.

You can follow Benny on Facebook and Instagram.

Cover photo courtesy of Ari Walker

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