In the last few years, helicopter evacuations have become the bugbear of any expedition medic working in the Khumbu. The financial rewards are so high for all those involved in arranging an evacuation, that stopping a patient boarding a heli is often much more difficult than getting them flown out. Insurance companies, wise to the situation, have become increasingly reluctant to bear the costs of evacuations. Helicopter evacuations carry their own risks and shouldn’t be undertaken on a whim. However, the latest, and by far the most serious casualty of this sad state of affairs is the forced closure of the IPPG rescue posts in Machermo and Gokyo, Nepal.
What do the rescue posts do?
Being a porter in the Khumbu is a tough proposition, but pays well enough to attract even those without experience of the mountains or altitude. Before the clinics, shelters and clothing banks were built, many porters were ill-prepared for the elements. Some slept in caves and occasionally, one succumbed to the effects of altitude and lost their life. The International Porter Protection Group (IPPG) and Community Action Nepal (CAN) built two rescue posts and porter shelters, offering food, a roof over the head and medical care for these deeply hardworking people. The model was sustainable, subsidised by treating Western trekkers at the clinics for a fair price. IPPG also offered free altitude education to those passing through the villages, a simple but effective public health intervention that likely saved many lives. Adventure Medic’s own Ellie Health and Matt Wilkes spent the autumn 2017 season working at the rescue posts and witnessed first-hand the immeasurable good that they do for the local population. The closure of the posts is a desperate loss, to the porters of the Khumbu, to the local staff employed by IPPG, to the mountain medicine community and to all those visiting this special part of the world.
Why are the rescue posts closing?
Dr Nick Mason, along with his wife Emma and many dedicated volunteers, have worked tirelessly to keep the rescue posts running over the years. Nick has written the following open letter regarding their closure.
It is with great sadness that I have to report the forced closure, with immediate effect, of the rescue posts in the villages of Machermo and Gokyo, Nepal.
For the last 17 years the International Porter Protection Group (IPPG) and Community Action Nepal (CAN), and in recent years with the support of the Mountain Medicine Society of Nepal (MMSN), have quietly and efficiently been operating a porter shelter and rescue post in the village of Machermo at 4450m above sea level. During the last decade they have been operating a similar facility in the neighbouring village of Gokyo at 4900m. Some of you will know the area well having worked for IPPG as volunteers.
In October of last year, without warning, a small private clinic in Kathmandu opened a satellite clinic in one of the lodges in the centre of Gokyo. Last season the clinic was staffed by a doctor qualified for less than one year and with no experience of altitude or travel medicine. He attended IPPG’s altitude talk for lay people and said that he learned a great deal! The business model for the new clinic would appear to be to evacuate as many trekkers as possible to Kathmandu where it is alleged they are often subjected to excessive or fictitious investigations and treatment. Those trekkers not evacuated are frequently subjected to excessive and sometimes dangerous over treatment and polypharmacy. Last season’s volunteer doctors for IPPG had the impression that up to 50% of patients seen at the new clinic were evacuated by helicopter compared to IPPG’s rate of around 5% and then only the most seriously ill. The helicopter company used for the majority of the evacuations from the new clinic is owned by a major shareholder in the Kathmandu clinic.
Many of you will be aware that IPPG’s funding for the free care of porters and local people comes from treating trekkers and charging them for this care. This just about covers the operating costs of the 2 rescue posts. With the new clinic opening in the centre of Gokyo and, for the first time since IPPG began working in Gokyo, hostility and abuse towards IPPG’s doctors from those lodge owners associated with the new clinic, trekkers attending the IPPG-CAN rescue post have already begun to fall. This would obviously have an impact on our ability to fund our work and so we had begun to look at the possibility of alternative funding arrangements. but unfortunately the Khumbu Pasang Lhamu Rural Municipality (local government for the Khumbu) have refused IPPG permission to operate in the Gokyo Valley for spring 2020 and subsequent seasons. Without this permission it is impossible for IPPG’s doctors to obtain a work permit and without that registration with the Nepalese Medical Council. The Khumbu Pasang Lhamu Rural Municipality has been in existence since 2017 and it seems more than a coincidence that it is only with the opening of the new private clinic that permission for IPPG to work in the valley has now been refused. It has proved impossible to engage in any discussion with the Rural Municipality.
In the 17 years that the posts have been open, thousands of patients have been treated; hundreds of lives have been saved and in excess of 30,000 people have attended the daily Altitude Talk and been educated on altitude illness and, even more importantly, how better to take care of porters. Tragically it is highly likely that with the loss of the medical and educational roles of the rescue posts, as a direct consequence of the decision of the Rural Municipality, deaths from avoidable altitude illness will increase in the Gokyo Valley.
We hope that the much needed porter shelter in Gokyo will continue to function. The shelter in Machermo has been a victim of its own success and a number of tea shops have subsequently opened in the village specifically to provide porters with cheap food and accommodation. It is now rarely used by porters. Prior to the opening of the shelters, porters slept in the open, under tarpaulins or in caves while the trekkers whose kit bags they had carried all day slept in warmth and comfort.
We have always viewed ourselves as guests of the Sherpas of the Gokyo Valley, having been originally invited into the valley by the local community and the Sagamartha National Park, and it has been a privilege to serve them. We looked forward to the day when we would be able to hand over the rescue posts and porter shelters fully to the Nepalese. Despite increasing difficulties over the last few years we did not envisage that we would be forced to stop caring for the porters and trekkers visiting the Gokyo Valley in such an abrupt manner. Nepal has undergone huge socio-political changes during the past decade and it is clear that for some influential people in Nepal our help is no longer welcome. It will be for the talented and inspirational young doctors of the MMSN to choose how to face these new challenges. It is to be hoped that they will strive to uphold the highest standards of medical practice in mountain medicine in Nepal and that they will be ably and robustly supported in this task by the international mountain medicine community.
Dr. Nick Mason PhD, FRCA, FFICM, FRGS, Dip Mtn Med
Chair of Trustees, IPPG(UK)
Registered Charity Number: 1143221
(Photos: Matt Wilkes)