Dr Suvash Dawadi, MD DiMM / General Practice and Emergency Medicine / CIWEC Kathmandu
“It’s your niggly coughs and upset tummies that are the bread and butter here” explained Brent over dinner to the trekker visiting us for the night at Everest Base Camp (5360m). Subs was on the phone to home and Dawa was still pushing his dinner around on his plate. Suddenly a Sherpa appeared at the dining tent, radio in hand, asking for urgent help. Other activities took second stage as the three doctors gathered to hear the news. There was a stricken climber at Camp 2 who wanted to talk with the Everest ER.
The climber had successfully reached the summit, but on his descent had developed extremely cold feet and had started to lose sensation in his toes. When he arrived at Camp 2, he took off his boots and much to his distress, discovered his toes were purple and completely numb: frostbite. The climber and the doctors all knew that there would be no option for helicopter evacuation in the dark and there was no point in further risking those frostbitten toes by walking down to Base Camp, another 5-6 hours in the dark and cold. The climber would have to manage at Camp 2 for the time being. “No rewarming” Brent instructed the climber, “We’ll have to get you a heli down to Kathmandu first thing tomorrow.”
The focus now shifted to the Base Camp manager for the climber’s team. He was advised to start making arrangements for a prompt helicopter evacuation for early the next morning.
Morning came around and the three doctors were nervous. They hadn’t seen or heard a helicopter heading up to Camp 2. Finally, news filtered through that the chopper was on its way. When the climber landed at Base Camp, the doctors finally got a look at his frostbitten limbs. The climber thanked the team for the medical advice they had given him on his ascent. This forewarning had given him a good idea of how to recognize and manage his symptoms when alone and exposed higher up the mountain. This feedback brought a great deal of satisfaction for the doctors; patient education and health promotion in action.
This is just one example of the type of case managed at Everest ER: a seasonal tent-based aid post which runs every year during the spring climbing season in the heart of ‘Tent City’: Everest Base Camp. Everest ER is a joint project of the USA and Nepali Himalayan Rescue Association (HRA). The HRA is a non-profit, non-governmental organization established in 1973. The HRA also runs two other aid posts; one in Pheriche in the Khumbu valley and another at Manang on the Annapurna Circuit.
Dr Luanne Freer established Everest ER in 2003 on the 50th Anniversary of Edmund Hillary and Tenzing Norgay’s pioneering summit success. It has been running every spring since and in 2018 completed a 16th successful season. The clinic provided much needed emergency response during the 2014 avalanche and 2015 earthquake, both of which had a devastating impact on Base Camp.
In the 2018 season, 397 patients received care from Everest ER. Almost ninety percent of the patients were male and sixty percent were Nepalese (Sherpa). Forty two helicopter evacuations were organized during the season, a few of them from Camp 2. The most common presenting complaints were upper respiratory tract symptoms followed by high-altitude (or “Khumbu”) cough. However, the variety of problems seen was wide, from the full spectrum of altitude illnesses to frostbite, trauma, cardiac problems, snow blindness, head injuries, the inevitable diarrhoea and a whole host of dermatological conditions.
There is no typical day at the Everest ER. The usual clinic-based consultations would be interrupted by tent calls, radio consults and sked carries at any time of day or night. Often people presented needing counseling or a motivating pep-talk. We even had intoxicated people to look after at times. You never knew what might stumble through the tent door! But that was the beauty of it. At the only organized medical facility in a 1500-strong Base Camp; a remote and extreme environment with limited resources, your clinical and improvisation skills become your most valuable tools.
The 2018 volunteer doctors were: Brenton Systermans; Emergency Physician from Geelong, Australia (back to the Khumbu after volunteering at Pheriche the previous year), Subarna (Subs) Adhikari; Orthopaedic Surgeon from Nepal, and me; Suvash (Dawa) Dawadi, General Practitioner from Nepal. We were valiantly supported by Lakpa Norbu Sherpa in his 16th continuous year working as supporting staff and longline rescue specialist. This season also saw two firsts in the history of Everest ER; an all-male team and two Nepali doctors!
The team at Base Camp was very well supported by the HRA team in Kathmandu, working effortlessly to make sure we were comfortable and had all we needed to function, including organizing restock of medications by helicopter from Kathmandu.
As I now sit at home in Kathmandu, back to working in the “low altitude setting”, I realize how lucky I was to be a part of this medical marvel. Sure, there were no life-saving procedures or heroics this season, but we had fulfilled our purpose: to keep the mountain safe and the climbers healthy. Managing the ‘niggly little problems’ can actually make a big difference to the comfort and experience of those working and playing on the mountain. Educating passing climbers and support staff about common problems at altitude and in how to stay healthy in the mountains, and hopefully preventing lots of mishaps along the way, was immensely rewarding. The smiles on the faces of those we had treated and made better, the social interaction with a group of people with so much dedication, discipline and passion for the outdoors was an privilege to be a part of.
The adventure medic in me got to experience this amazing two month journey. If you are interested in finding out more about volunteering with the HRA or making a donation, head over to www.everester.org. As the Everest ER is a charitable project, every little helps. If you happen to be at Everest Base Camp during April or May, take a wander down to Everest ER (you may need to ask around for directions!) and experience it for yourself. You are sure to get a warm welcome.
About the author
Dr Suvash ‘Dawa’ Dawadi was one of the Everest ER 2018 volunteer doctors. He currently works in a general practice and emergency medicine setting at the CIWEC Hospital and Travel Medicine Centre in Kathmandu. He holds the Diploma in Mountain Medicine (DiMM). He tries to get out to do expedition medicine whenever he can.