Rachel Anderson / Expedition Doctor
It’s easy to get trapped in the medical life. There is always another rung on the ladder too close to hand. Rachel Anderson decided to do the opposite. In 2009 she took a trip to the Himalayas. That led to a sprawling, multi-year adventure, taking in Everest, the Pole, and then Everest once more. Here, she walks Adventure Medic through her extraordinary time.
May 2012, Camp two on Everest. It was 9pm and I was in a small, cold, dark tent with my friend David Hamilton of Jagged Globe, listening to a crackly BBC World Service. Manchester City won the Premier League in the final three minutes of injury time. I lay there, breathing in the thin air of 6400 metres savouring the thoughts of my family celebrating back home. It was quite a moment but thinking back, there have been lots of special moments in the last few years: standing at the South Pole with Grant, a man who’d skied the last degree on a sit-ski after a snow mobile accident two years before; flying out of base camp with a welsh rugby player who had got frostbite on the summit; mirror signalling a Russian cargo plane in to land on the ice of Antarctica; or just hanging out with friends wearing down jackets playing Texas Hold ‘Em poker knowing that I had a full house on the flop. It’s been quite an adventure and it all started in 2009 when I decided to leave my Emergency Medicine training post in search of fun and high times in the Himalaya.
I’d met the Himalayan Rescue Association team at the World Mountain Medicine Congress in Aviemore. After teaching Dr Ken Zafren how to Ceilidh and harassing the Kathmandu office with emails, I finally got the job of working in Pheriche, a clinic on route to Everest for the autumn of 2009.
There were four of us from the UK working together. Myself, a paramedic and a GP and her partner alongside a Sherpa cook, the legendary Ang Rita and Bhuwan, a special young Brahman from Kathmandu. We hiked up through stunning scenery on a trail I have come to know very well with yaks carrying our medicines and kit. The clinic is open during spring and autumn seasons when climbers and trekkers are in the area. It serves the local people well, being the only place for healthcare within a ten-mile radius. There are no roads. We’d heard stories of bleeding PPH’s receiving blood from relatives and being carried down to Lukla from Dr Kami at Kunde Hospital.
So, we arrived at Pheriche with a little fear and a lot of excitement at what was to come. It was a great season treating over five hundred patients, half locals and half westerners, with a variety of problems ranging from High Altitude Cerebral Oedema and pneumonia to the dreaded Delhi belly. As they say, ‘there are those trekkers who have Delhi belly in the Khumbu and those who are about to get it’. Fortunately with Ang Rita’s huge portions of delicious chicken curry and dal we were safe and well fed.
Most days were calm: lectures on altitude sickness for the trekkers coming through, treating the odd yak with conjunctivitis or a horse with a fractured jaw. When the loud door-bell would ring though, you’d know that there would be a porter with a sick patient on his back, having carried them down from higher up the valley. And they could be really sick, often with oxygen saturations below 50%, cold and barely conscious. We’d give them a dose of dexamethasone, nifedipine and Viagra and put them in a Gamow bag on oxygen. It was satisfying to watch them wake up and recover, but as we all knew – it was the locals bringing people down to the clinic that really saved lives.
During my time in Pheriche, we all managed trips away. I climbed Island peak and Lobuche East and came down over the Cho La pass through Gokyo and its incredible blue lakes. Sitting at the sixth lake under the towering Cho Oyu with no-one for miles around and the thought of snow leopards nearby was an inspiring moment. Struggling up the fixed ropes of Island peak in a gale gave me my first taste of high altitude mountaineering. Whilst I love my Munro bagging as much as the next girl, it has to be said that standing on a 6000m peak looking up at the Lhotse Face does leave you wanting more.
Dr Freer and Everest ER
We were also lucky to meet Dr Luanne Freer whilst working in Pheriche. Some years ago, she had trekked up to base camp to find the local community poorly provided for, as well as a general lack of understanding of altitude medicine amongst the medical practitioners. Over the last ten years there have been huge improvements in the practice of altitude medicine. This is likely a result of more interest in adventure travel as well as the availability of courses on expedition medicine worldwide. With consensus and collaboration we now have Wilderness Medical Society guidelines to aid our practice and even a Diploma in Mountain Medicine based here in the UK. Things have certainly changed. Through hard work and dedication Dr Freer set up a medical clinic tent at Base Camp, the Everest ER.
The ER has developed and grown over the last ten years and now has a wooden floor and two beds for overnight stay and consultations. Dr Freer tends to choose volunteer doctors who have worked in Pheriche before, as she knows they have an understanding of altitude medicine and an awareness of the local culture. We were lucky enough to be asked to join the Everest ER team for 2011. I must say that initially I wasn’t sure. I’d heard about these high altitude climbers and thought the egos might be hard to handle. Still, how could we possibly refuse such as offer?
The first weeks were incredibly cold and windy. What on earth was I doing here in this godforsaken place?! However, as the season went on and the sun warmed our cold toes, I fell in love with the place and the people. Like Pheriche, Everest ER serves a mix of Sherpas and climbers. Most climbing teams voluntarily sign up to the clinic. They pay $100 per climber for as many visits as they need, which also enables that team’s Sherpas to come for free. It’s a great system. Over the years, and particularly since the introduction of Nepali doctor Dr Ashish Lohani, the Nepalis’ trust in the clinic has grown. We see more and more locals each year. We run clinics during the day and see emergency patients anytime. We organise helicopter rescues with the teams and our Sherpa Lakpa Norbu. Sherpa Lakpa is from the Khumbu, knows everyone, has a wicked sense of humour and is a great asset to the clinic. At certain times in the season, especially when the climbers are down at Base Camp in between rotations it can be very busy. At other times it’s much quieter. We have a chance to read, play backgammon and drink the odd glass of vino.
Whilst I used to be scathing of commercial climbers, I now see how much safer they have made the mountain and what a privilege they bring to many people who otherwise would not be skilled enough to be there. This is a controversial topic and I know that many would say the mountain should be saved for ‘true mountaineers’. I used to be on this side of the argument but there are many remote Himalayan peaks that can still be climbed without assistance. Seeing the improvements to the local people’s lives is enough to convince me that without a commercialised Everest, Nepal would be a lot poorer. It’s true that the Khumbu valley is no longer the remote place it once was. There’s now internet, hot showers and Coca Cola. Of course some people are making money but who are we to keep Nepal in the past and deny the people progress? Indeed, the climbers we were concerned about working alongside have now become some of our firm friends. Despite the media hype, Everest is actually a place where people work together. Yes, there are disagreements between teams. However, when there are problems on the mountain most come together to get involved in the rescue.
It is an amazing feeling to be part of a Himalayan rescue. Whilst the HRA does not send rescuers up the mountain, it has a key role in organisation from the base and is able to give radio advice to the climbers and guides up high. We also run informal teaching days for the Sherpas, alongside mountain guide and climber Willie Benegas of Patagonian Brothers, covering altitude and trauma medicine. Finally, as there are increasing numbers of high helicopter rescues, we are at the helipad receiving injured casualties for stabilisation. This year we had over twenty five evacuations, mostly by helicopter.
It’s the people you meet
Whilst at Base Camp, we hung out with various other medics. Some teams have their own dedicated doctor and commonly we would work together on a difficult case or sit over a fresh coffee chatting about life on expeditions. That was when Antarctica came up. I was meant to be returning to NHS work that August but decided to make some enquiries anyway. Like anything, once you’re in the business and know a few people, opportunities can arise seemingly from nowhere. Indeed, in no time at all, I was offered an eight week rotation on the ice working for Antarctic Logistics and Expeditions at their base on Union Glacier, through Dr Martin Rhodes. Better yet, I would actually get paid! ALE organise the logistics of travel and evacuation for expeditionaries, skiing, kite skiing and even running various routes across Antarctica and to the Pole. They also have the monopoly on Mount Vinson trips. That year was particularly special as it was the centenary year, 100 years since Amundsen and the ill-fated Scott arrived at the Pole. That also meant ‘soft tourists’, taking trips to the Pole for the celebration as well as visiting the Emperor Penguins. Alongside that, there was also the Lake Ellsworth project. ALE were transporting a 4km pipe for the British Antarctic Survey to drill down to an ancient lake deep in the ice. From their samples, they hoped to shed light on the origins of life. What could be more exciting than that?!
I left the UK in early December 2011 on all expenses- paid flights to Punta Arenas on the Southern tip of Chile. Once Punta Arenas was a wild outpost where many trips to Antarctica began but it now houses a few good restaurants and bars including an expensive rooftop joint serving mojitos. I arrived halfway through the season and boarded a Russian cargo plane modified to land on an ice runway, with 40 tourists heading to the Pole. You’d be amazed how people turn up. I went on a gear check to discover that one couple didn’t have hats and only a pair of thinnie gloves. They were advised to go shopping. Fortunately the expeditionaries and mountaineers were better prepared. Indeed, there were some truly hard core people kicking about. An Aussie had run from pole to pole over the previous two years, a Japanese man who had crossed Antarctica with an expedition 30 years ago when there were still dogs and who survived a night in a snow hole and a British girl who crossed the pole on skies entirely alone, living through intense katabatic winds night after night.
While I managed two trips to the Pole, I have to say that it was in the warm comfort of a 12-seater Twin Otter. Still I helped take the camp down at the Pole in -35 degree temperatures so at least I’ve had a taste of what it was all about. I was there for New Year and also the Scott centenary where we arrived during the night. Or, was it the morning? Who would know, with 24 hour daylight and an eight hour time difference between us and the American base one kilometre away? The pole is at 2800m, over 3000 if you bear in mind that the air is thinner at the pole than at the equator. Arriving there, playing cricket, visiting the base and celebrating the centenary with a glass or two of wine meant a rough next day.
Catching up with old friends from Everest however was a real treat. The guides do the rounds and meet at various cool places in the world. I suddenly realised I was a part of this. Still, in honour of Scott, at least the Brits won the cricket. In fact over the two months there I learnt a lot about those early expeditions. We had a Swedish expeditionary who was also a polar expert and lectured us on the history of polar exploration. Hearing how Scott saw the dog prints in the snow and realised that they had been pipped by the Norwegians suddenly meant something to me. They nearly made it home too: Just 15 miles away from their food cache they became exhausted and perished in the harsh conditions, an on-foot expedition that no-one has repeated since.
Medicine in the Antarctic
There was some medicine too. The tent was well organised with a cosy fire, new that year and with enough kit to manage most emergencies. Unlike Everest where anyone could climb, ALE had all the business on the ice and as a result it was like a well-oiled machine. The medics were just a small part of what was a huge enterprise. Working alongside mechanics, chefs, pilots and meteorologists from over twenty different countries was a real treat and the highlight of being there. We saw a fair amount of frostbite and trauma and with the Antarctic marathon even had a case of rhabdomyolysis that year. The medics tended to be British as was the boss, Doc Martin, with whom the banter was endless.
Christmas was a huge event with turkey and the trimmings and a talent show in a specially darkened tent, a recipe for debauchery made all the more inviting by rare darkness. Strangely enough, inside the tents it was warmer than on Everest, with good heating in the communal tents and the never-ending sun. Putting sun cream on at midnight was bizarre and realising it was 3am and you were still up chatting with friends in bright sunlight was impossible to get used to. After two months there, most people were severely sleep deprived. Like any remote place there were some personal stresses and issues between the staff. The medics were expected to offer counsel and listening was a big part of the job. Getting out of camp was a blessing, difficult on an active glacier where new crevasses were constantly opening up. Skiing away from the buzz of machinery into the vast emptiness and hearing the absolute silence is something I’ll never forget.
Back to Everest
Finally, I couldn’t resist the draw of returning to Everest. The winter had been dry so there was less snow on the mountain. Warm days during the season meant the icefall and the Lhotse face were unpredictable. We had a major avalanche between Camp One and Two and more than one crevasse rescue. There was also the terrible tragedy of too many climbers on the mountain, when six people died waiting in queues. With very short summit windows, it was a scramble for the top. Those who opted wisely to wait out this busy period did well and the second summit push went smoothly. For us at Base Camp it was a stressful time. Knowing that people were up high dying and that we were unable to help was awful. As usual the main teams worked well together with various rescues and many meetings about how to make the mountain as safe as possible. With over three hundred people on the mountain and little control over the figures this was not an easy task.
Still, there was fun amidst the drama. I was fortunate enough to be on a permit and in between these busy periods I made my trip to Camp Two. The icefall is an awe-inspiring place. We crossed the infamous ladders, listened to the Sherpas chant through the avalanche zone and watched the sun hit Pumori across the Khumbu Valley. Being totally alone in the Western Cwm, moving ever so slowly up to Camp Two is something I could never forget.
What an adventure it has been.