Matt Wilkes / Adventure Medic Editor
One hundred paraglider pilots, 660 porters, one 5895m mountain and three doctors. The story of Wings of Kilimanjaro: the record-breaking attempt to fly from the summit of Kilimanjaro to Moshi. A tremendous experience for the doctors involved, Matt Wilkes, Luke Summers and Matt Knox – read on for their tale of friendship, altitude, hunger, thwarted ambition and one crazy Nepali.
It’s November 2013 and I am sitting contentedly, deep in New Zealand wine country. I pick up my paragliding magazine and there, amongst the pages, is the most captivating project: Wings of Kilimanjaro. In two months, two hundred paraglider pilots and seven hundred porters were to climb Mount Kilimanjaro, camp on the summit, and then fly from Stella Point to the town of Moshi. All to raise one million dollars for charity. Unique, daring and beautiful, I could just imagine all those bright-coloured wings soaring past the glacier, filling the African sky. I wanted to be there.
Wings of Kilimanjaro
Wings of Kilimanjaro was the brainchild of Adrian McRae: an entrepreneur and paraglider pilot from Australia. He had traveled previously in Tanzania, hoping to paraglide from Kilimanjaro but soon learnt that it was illegal. Others had flown from the summit before: Bertrand and Roche in 1999 and Toma Coconea in 2007, but these flights were against the law. It was also rumoured that another pilot had died after landing in the forest during another attempt.
So, Adrian struck a grand bargain with the government of Tanzania and the Kilimanjaro Park Authority: if Adrian could raise a million dollars, they would let him fly from Kilimanjaro. His plan – to recruit 200 pilots, charge them 5000 dollars each, and fly from the summit.
I emailed. I knew that they would already have a medical setup, but I thought I might be able to sneak my way in: play the Doctor Card and get to go along, and maybe even a flight. Unfortunately, I didn’t hear anything back. Some weeks passed and I tried again. Finally, I got a message back – I could come.
In or out?
At that stage, the medical side of things was still in its infancy. Adrian and his sister Paula were already in the process of arranging an air ambulance, and they had approached two experienced doctors. However, the doctors in question had significant commitments at home and would struggle to come.
Beyond that, the organisers had assumed that as some of the paraglider pilots on the expedition were medical (an eye surgeon, a sports’ rehabilitation doc and a flight nurse) that they could handle any emergencies that arose. The expedition was driven by hugely ambitious and optimistic people – they had put enormous effort into logistics and into securing the rights to fly from Kilimanjaro. The organisers weren’t callous about the risks, but their attitude was one that admitted little possibility of failure. It felt a little bit like starting from scratch.
I thought hard and took advice from as many as would give it. Mark Hannaford, Sean Hudson and Amy Hughes of Expedition and Wilderness Medicine were particularly helpful and encouraging, as was Julian Speight at Southland Wilderness Medicine Group. I felt very out of my depth: it was such a huge expedition, I had visions of multitrauma, there would be tandem paragliders there – two could crash in midair. There would be altitude sickness, there would be D&V. There were thirty Americans on the trip, so indemnity would be a big issue. The ascent profile was sensible, and the organisers had put a lot of thought into logistics but if it went wrong, any doctor there would be exposed to big professional risks.
As with many of these decisions, it came down to this: could I live with myself if disaster unfolded and I was still sat at home?
I was in, but there was no time to lose. We had to recruit a team, think about the risks, make some CASEVAC plans, screen participants, sort out a medical kit, indemnity and write a safety briefing. All in two months.
Recruiting a team
First and foremost, I knew I would need a lot of help. In my ideal world, I wanted one to two senior expedition doctors, two registrars, one Kiswahili speaker and two nurses or paramedics. However, the expedition was already severely in the red and could not afford more than three practitioners.
A month before we were due to leave, the medical team consisted of me and my mate Luke. Luke is an Emergency Medicine Registrar and one of the editors of Adventure Medic. We then added Matt Knox, another Emergency Medicine doc and a Diploma in Mountain Medicine holder. While Matt K didn’t speak Kiswahili, he did at least speak Australian. I genuinely could not have wished for a finer team.
Risk assessment – what could possibly go wrong?
Our main concerns were: altitude illness, infectious diarrhoea, logistical problems and trauma. Kilimanjaro is renowned for its high rates of altitude illness, particularly amongst those undertaking a four-day itinerary, so we were somewhat reassured by our plan to take a modified version of the seven day Machame Route.
Given the size and diversity of the group, and the facilities available on Kilimanjaro, we felt that an outbreak of diarrhoeal illness was also very likely. After reviewing the literature and following helpful discussion with Professor Mike Jones of the Faculty of Travel Medicine, we elected to treat any diarrhoea promptly with a single dose of 500mg ciprofloxacin. We would supplement this with fluids, Imodium and antiemetics for symptomatic relief and azithromycin for second-line therapy.
Logistically, we were concerned about food and water supply, the possibility of losing people on the climb or the flight, and communications in general. The group would be organised into ten teams for the ascent and the pilots had SPOT trackers and 2m-band VHF radios for the flight.
Our main preoccupation was still trauma: road traffic accidents on the way to the mountain, twisted ankles on ascent, failed launches and crashes mid-flight and on landing.
Because paraglider wings are inflatable, they can collapse in turbulent air. Though these collapses usually reinflate within 2-3 seconds, if they occur close to the ground an accident can follow. As can be seen from the pictures up above, a crash mid-flight would involve retrieval from dense forest. The landing field was surrounded by power lines and a primary school. Also, some paragliding accidents are due to incorrect preparation of equipment – forgetting to do up leg straps in particular. That could be a concern for a group of exhausted pilots, freezing in high-altitude conditions on top of Kilimanjaro.
Casevac planning was a lengthy process. Adrian and Paula were already well ahead on recruiting an air ambulance for the landing zone, but we still needed to appoint a Ground Coordinator and find a potential receiving trauma hospital in Dar es Salaam. Our resources would be our guides, porters and Park Rangers (KINAPA).Our limitations would include the weather conditions, the altitude ceiling of the helicopter (13,000 ft) and the potential for multitrauma.
Screening the participants was a priority – who was all coming? It turned out to be a fantastic mix. There were international outdoor stars, such as Babu Sunawar, the National Geographic Adventurer of the Year, pilots Mike Küng, Mario Eder and Kari Castle, Squash Falconer and a number of other serious summiteers. The rest were just as interesting but from vastly different walks of life: from a South American freediver to the Commissioner of the City of London Police. In common, they had all raised a huge amount of money: 5000 USD in charitable contributions, 3500 USD in climbing fees and 1500 USD for flights. This would make vetoing any participants on medical grounds fraught with difficulty.
There was also a TV crew from Australian 60 Minutes, and a specialist remote control helicopter film unit. All very good company, and better yet, we avoided having to take any ‘celebrities’. At one stage in the preparations, we found ourselves on the phone to the manager of a relatively well-known pop starlet:
Manager: Can you assure me that if X comes on the trip, she won’t be hurt or killed?
Manager: Why not? I mean, it’s X?!
Me: Yes, but she plans to paraglide off a 19,000 ft mountain. There really is a very good chance she might be hurt or killed.
Manager: Would that stop her performing…?
She didn’t come.
Putting together the kit was the responsibility of Luke, with help from Amy Hughes, and they did a mighty fine job. It was extensive (72kg), given the size of the trip and the potential for trauma during the paragliding phase. From Tanzania, we also obtained six ‘Size D’ oxygen cylinders, two spinal boards (vacuum mattresses and scoop stretchers proved hard to obtain in country) and intravenous opiates. However, the most useful items that we brought turned out to be aloe vera for the relief of sunburn, paracetamol and ibuprofen, dexamethasone and acetazolamide for treatment of altitude illness, and ciprofloxacin for travellers’ diarrhoea.
We were pretty worried about indemnity, me especially. I had brought Luke and Matt K into this and knew how bad I would feel if I landed them in court. Americans, Canadians, Australians and multitrauma? It did seem like a fantastic way to get sued. Eventually, we were able to agree the ‘standard deal’ with MPS: they would cover us if an action was brought in Tanzania or in the UK. If we were sued in an American or Canadian court then MPS would try to transfer it back to the UK or Tanzania. However, if they were unsuccessful then we would not be indemnified. That would have to do.
We covered all the usual stuff – vaccinations, altitude and malaria prophylaxis, bite prevention, hygiene and diarrhoea, environmental hazards, blood transfusion and trauma, travel insurance and repatriation and emotional aspects of travel.
However, a unique priority in the briefing material was to prepare pilots for the possibility that they might climb the mountain but not be fit to fly. The pressures to take off would be immense: the pilots would have raised 10,000 dollars, be surrounded by the best of their peers and be on top of Kilimanjaro with the world watching. We wanted to pre-empt any arguments from those who might end up unfit to fly. With the help of Dr Ali Simpson, we decided to come up with a scoring system, which we introduced to the pilots before the ascent. It looked at various aspects of coordination and altitude illness, using the pilot’s own pre-flight checks as the test. It had the advantage of not interfering with anyone’s preflight routine and hopefully would back up anything we said up top.
In the days before the climb, we had the usual experience of people sidling up to us and confessing various maladies that they had ‘omitted’ from their medical forms. Some were quite startling in their severity. However, after a few days, we were ready to go. Piling into half a dozen buses, we set off for the hill.
The action started straightaway when one of the buses hit a porter in the chaos of Machame Gate. Not an auspicious beginning. Still, we examined the poor chap, gave him fluids and analgesia, packaged him up and took him to Kilimanjaro Christian Medical Centre. There, we were relieved to learn that his injuries were not as bad as we had first feared. As unfortunate as this incident was, it did enable us to check out our systems and gave the group confidence in our abilities to deal with an acute situation.
We were busy all the way up the climb. Though in the end there were only 100 paraglider pilots and 660 porters, instead of double the numbers as originally planned, there was still plenty to keep us going. We dealt with altitude illness, D&V, asthma, anxiety, blepharitis, central chest pain, pyrexia of unknown origin, fractures, menorrhagia, hypothermia, blisters and sunburn. No twisted ankles though!
HACE and HAPE
At 4100m, we encountered a Norwegian party, spotting one of their number staggering out of the toilet. Her gait was wide-based and unsteady and she soon fell, hitting her head on the rocks. We went to her and found her confused, severely short of breath, cold peripherally, tachycardic, with unrecordable oxygen saturations and crepitations in all her lung fields. It was the severest case of altitude illness that we saw: mixed HACE and HAPE. She was particularly unwell. We quickly treated her with intravenous dexamethasone, oral nifedipine, acetazolamide and oxygen from the kit.
We patched up her head, packaged her up in a sleeping bag and sent her down with the porters. We couldn’t accompany her – it was nearly dark and we needed to be with our own group. We’d have probably just slowed the porters down. However, it still felt like a horrible decision to let her out of our sight, even though she was improving with treatment. A lesser but important concern was also that we got our gear back. We knew that every piece might matter up top. We were very relieved to find out later that she had made a complete recovery, as well as to see our kit back in camp.
Kilimanjaro has a pretty bad reputation for a number of reasons – not only for too-fast ascents but also for under-equipped and thoroughly exploited porters. It goes without saying that the health of our porters on the expedition was of equal importance to us and to the organisers as that of our pilots. However, because we came on board so late in the day, as doctors we were not able to devote as much time as we would have wished to porter health prior to the climb. We were forced to accept the assurances of the guiding company that porters would be well equipped and provided for.
This was a mistake. We, as well as the organisers, were consistently depressed by how ill-equipped some of the porters found themselves on the ascent. The guiding company’s medical kit and experience was utterly inadequate to treat their own staff. Many of the group generously gave them spare gloves and gear but we still spent much of our climb looking after our porters and guides.
Indeed, given the size of the expedition, it turned out that many of our porters had been recruited from local villages having never climbed Kilimanjaro before. They were scared. We treated a number for hypothermia and, in two instances, high-altitude pulmonary oedema requiring oxygen, intravenous medication and rapid descent. Others complained of a mixture of symptoms, possibly related to overexertion and anxiety.
Our experience is one of the many reasons why the Adventure Medic editors are now such keen supporters of the International Porter Protection Group.
After six days, we reached the top. We were jubilant – we had safely summited 100 pilots to the top of Kilimanjaro. We’d beaten the odds and set a new world record. Seeing Paula, Adrian and the rest of the organisers reach the summit was wonderful. However, we were still only halfway there, with the most dangerous phase yet to come.
Indeed, when we walked down to Crater Camp just below the summit, the weather was fast deteriorating. The temperature reached -20°C and there were strong winds that made it feel colder still. Worse, following a dispute between the guides and the junior porters, the food and water supplies were interrupted. It had suddenly become dangerous: storms, high altitudes, darkness and little to eat or drink. Morale dropped and it was a difficult night. The pilots were dehydrated and demoralised. Arguments broke out. We had only been able to provide a litre of water per person from melting snow. The organisers did their best to get the supply chain back on track. The docs and organisers went from tent to tent, dealing with problems as they arose but we knew that we couldn’t stay on the summit unless food and water were restored.
About one third of the group went down the next morning – uncertain about the weather, and fed up with the altitude, cold and meagre rations. One had developed pyrexia, though her malaria RDTs were negative. The remainder stayed, hoping for a resumption of supplies and an improvement in the weather. A small amount of food and water came up from the camp below. It was not enough to sustain the group, but more was promised. With supplies on the way, it seemed reasonable to stay for another night.
The food and water never arrived. Instead, the weather closed in further. The final night on the summit was hard work for the organisers and doctors. Two people collapsed, though they responded well to oral fluids and Haribo (the exped doc’s friend). Latent medical problems surfaced as morale dropped. Another pilot developed chest pains, and his lungs sounded a little wet. He had a history of ischaemic heart disease. It was too late to evacuate him, so we thought we’d have a crack at the Gamow bag.
Into the Gamow Bag
A Gamow bag, or ‘Portable Hyperbaric Chamber’, is like a giant air-tight bivvy bag. The patient is zipped in and the bag is pressurised using a foot pump. By increasing the pressure inside the bag, you can effectively ‘descend’ a patient up to 1500m, until such a time as they can be evacuated.
Our Gamow bag worked a treat… on the second attempt. The first time around, I forgot my basic anaesthetics: when a gas is compressed, it rises in temperature. Anticipating that our patient would be cold, we wrapped him up warm, sealed him into the bag and starting pumping it up to pressure. Within ten minutes, we were extracting a sweaty and pissed-off South African – the temperature in the bag had become unbearable. On our next go, we put him in a T-shirt and it was a success.
We had been up all night and the following day dawned no better. Huge lenticular clouds filled the sky, indicating violent winds below launch. The team no longer had any faith in the supply chain and another night spent with limited food or water would be dangerous for all concerned.
Wings of Kilimanjaro had been years in the planning. Hundreds of thousands of pounds had been raised and an incalculable amount of human effort ploughed into the dream of flying off Kilimanjaro. We were all here. All the paragliding equipment was here. The temptation to hold out a little longer for flyable weather was huge.
But we knew that we couldn’t do that. We were there as doctors and it was our responsibility to call the trip off on safety grounds. To their eternal credit, Adrian and the other organisers supported our decision. Amid the chaos of a cold and hungry summit, we gathered together the remaining pilots and porters and went with them down the hill. A helicopter drop organised by Adrian of some (very expensive) Snickers bars and water kept spirits up on the way down, helping some get off the summit who would otherwise have struggled. It wasn’t enough to save the trip.
Everyone went down…?
Well, nearly everyone. Nepali pilot Babu Sunawar decided to remain behind at Barafu Camp. The following day, he and his guide jogged up 1000m to the summit and took off on a tandem into thick cloud. It was a controversial and risky thing to do and they had a relatively torrid course through turbulent air. We were very glad to hear that they landed safely near Moshi. One pilot at least had flown!
Medically, the trip was a great success. On two months’ notice, we had helped an enormous international group summit and camp on Kili. Despite bad weather, food and water shortages, 100% had made it up and down safely. In reality though, we were just as sad as everyone else that it hadn’t gone as planned. We grieved with Adrian and the rest of the crew: his sister Paula and her friend Sophia, the two flight officers Pete B and Mike, the Ground Coordinator Adrian, Pete G and the film guys.
The walk down the mountain was a quiet and reflective time. As the doctors, we were last off the hill. We wondered what would greet us when we got back to the hotel. Obviously, the weather could not have been helped but the failure of logistics? How would the pilots react to the organisers once the relief of being down had worn off, and they could think about what might have been?
At the hotel, everyone gathered and the organiser Adrian did a brave and honourable thing. He stood up in front of the whole expedition and did his best to explain why things had gone wrong. He also honoured his promise. Despite raising less than half a million dollars, he went on to donate the million, making up the rest from his own funds. In turn, the pilots responded admirably. They understood the sincerity of what had been attempted.
The days that followed were spent visiting some of the projects that Wings of Kilimanjaro had helped. It underlined the good that had been done despite the lack of flying.
And in the end…? In the words of Adrian McRae himself:
It’s not an adventure if you know how it is going to turn out.
What did we learn?
For Matt K, Luke and I, Wings of Kilimanjaro was a huge learning experience and has done much to set us up in the world of expedition medicine. Here are some of the lessons that we took away from the trip:
The power of veto
Wings of Kilimanjaro was a large international group and we were rushed. However, we still should have contacted all the participants’ primary healthcare practitioners to confirm their medical histories in advance. The medical forms alone were not enough and there were a number of conditions disclosed during the expedition that would have been very beneficial to have known about beforehand. Never wholly believe the medical forms and always retain your right to ‘veto’ participants you feel unsuitable to take part, irrespective of how close you are to the date of departure.
Positioning on the hill and communications
Given the size of the group, it was to be expected that people would become very spread out during each day of climbing. Given that there were only three doctors, maximising our resources was key. In the end, we found the most effective way was to position one doctor near the front of the climbers with a ‘grab bag’ of essential resources and have two doctors at the back with the bulk of the kit. Rotating roles allowed us to be more visible to those on the hill and also gave a psychological boost to the doctor at the front. We all found being at the back, walking at the pace of the slowest climber quite tough at times.
We tried to use 2M band FM radios to communicate between the teams. These were relatively powerful, but had short battery life and worked on line of site. Mobile phones were more effective but reception was still patchy. A more versatile communications system would have been better.
Treating illnesses promptly
Given the size of the group and our limited numbers, we felt that taking a ‘watchful waiting’ approach with unwell participants might have been unwise. Therefore, we aimed to treat any illnesses, be it altitude sickness or infectious diarrhoea, promptly and relatively aggressively, with evacuation a ready option. This worked well.
The expedition confirmed our view that the health of expedition porters was and is paramount. Adrian and Paula were right to approach a local guiding company. After all, the whole ethos of the trip was that money should go into Tanzanian pockets. However, as doctors, we should assure ourselves that porters are appropriately selected and equipped, both on practical grounds and as a moral imperative. It was a truly upsetting experience being surrounded by cold, frightened young men while on-call overnight at Barafu camp. This was just a flying expedition and despite our good intentions, we had all colluded in organising their suffering for the sake of a hobby. In future, we will make sure that any company we work for adheres to the Recommendations on Ethical Trekking made by the International Porter Protection Group.
Teamwork is all
The three of us got on very well as a team. We shared a similar outlook on life and were willing to accept each others’ advice. It meant that the expedition was huge amounts of fun, and even when times were hard we could pull together to present a united front. If you are going on a big trip – take your mates.
You can see the Australian 60 Minutes take on the expedition, Mountain Madness, (well, it’s a headline) here. To donate to the causes receiving ongoing support from Wings of Kilimanjaro, please visit the website.