Hannah Evans / Adventure Medic Staff Writer
The view from her office is the world’s highest peak. By her own admission she has ‘the best job in the world’. In 2003, American ER doctor Luanne Freer, motivated by the lack of healthcare available to climbers and the hundreds of Nepalese working on Everest, founded the world’s highest medical facility at 5345m. Adventure Medic Staff Writer Hannah Evans caught up with her and here’s what she had to say.
Thank you so much for taking some time out to answer some questions for Adventure Medic. First things first…. what a great career so far – truly inspirational!
Can you give us a potted history of your path through the world of expedition/wilderness medicine?
In 1992 I finished my Emergency Medicine residency training and took my first job in Yellowstone National Park. In 1994 I did a study on the incidence of Acute Mountain Sickness (AMS) in Yellowstone and presented my research findings at the Wilderness Medical Society (WMS) meeting. I became a member of the WMS where I found many kindred spirits! In 1999 I was asked to join a volunteer group of doctors going to provide a clinic in Lukla and trek to Everest Base Camp (EBC). I fell completely in love with Nepal!
In 2002 I worked as the sole member of staff at the Himalayan Rescue Association (HRA) Pheriche clinic. I discovered that there was a lack of trained health care at EBC, and conceived of the idea of extending the HRA up to EBC. Tenzing Norgay’s grandson Tashi encouraged me and offered his help. 2003 saw the first season of Everest ER… and we are just about to finish our 12th season.
What do you think drew you to a career in this field of medicine?
I’ve always loved the mountains. Yellowstone showed me how to combine medicine with the mountains and the passion just grew.
What do you consider to be your ‘day job’?
I am associate medical director at Medcor, a large company that holds the contract for medical services in Yellowstone. I manage other clinics for the company as well. They support Everest ER by letting me take off to fundraise and run the clinic. They have been very generous.
Tell us a bit about Everest ER, and why it is so important
The Everest Base Camp Medical Clinic, or Everest ER, is a project of the Himalayan Rescue Association-USA (a US based non-profit charity organisation) and the Himalayan Rescue Association (a non-profit Nepali NGO) and was first established during the 2003 Everest 50th anniversary spring climbing season. The clinic is able to supply free or heavily subsidized medical care to local Nepali people by charging climbing teams a nominal fee.
In 2002 I volunteered for the HRA’s Pheriche clinic—a remote stone outpost accessed only by a five-day hike up to 14,600 feet. This was established in 1973 and is located at an elevation where, historically, altitude-related problems begin to become apparent in trekkers who have ascended too quickly. During that year, I thought about developing a satellite clinic for the Himalayan Rescue Association at the base of Everest. I noticed there was no facility to care for the patients from expeditions without a doctor. I also became concerned about the gap between many doctors’ experience and the realities of expedition medicine. Being at Pheriche and seeing lots of people being sent down off the mountain only confirmed the need for the clinic.
There must be a fair bit of clinical complexity and uncertainty. How do you deal with that?
I’m an ER doc – so I’m pretty ok with not knowing the exact diagnosis, but attending to the issues at hand. It seems natural to me. I realise it’s an uncomfortable situation for some doctors, but perhaps Yellowstone got me ready for the bigger and more remote issues on Everest.
Do you have any ‘Freer gems of wisdom’ for dealing with altitude related problems?
I can’t claim them as my own – they were well known before I arrived, but the most important is never ascend with symptoms. It comes back to bite you every single time.
What is special about Nepal for you?
The people. The culture. The attendance to what is really important in life rather than how much you can achieve or how much material stuff you can accumulate.
Any poignant experiences you could share?
Tons of them. I’ve seen a lot of patients with severe high-altitude pulmonary oedema (HAPE) and high-altitude cerebral oedema (HACE). One chap who comes to mind had been brought down through the Khumbu Icefall – over 7,000 feet – to our medical clinic at EBC. I was really concerned that he might not make it through the night. His face was blue, each breath was a struggle, and he was drowning in his own blood. It was too dicey for a helicopter to land. The air was too thin, it was dark and snowing, and we already had the remains of one helicopter from years past sitting outside our tent. By the next morning, conditions had not improved. We put him in the Gamow bag, artificially lowering his altitude. That bag blew up. We put him in another, and it held. He pleaded with me to stay in the medical tent until the helicopter could land. I was concerned that his HAPE would get worse unless we got him down quickly, yet we couldn’t wait for the weather to clear for the chopper. This man was as close to death as I’ve seen from HAPE, but thankfully he recovered.
What skills and attributes do you think are the most useful for the wilderness medic?
Being open to improvisation, and being ready to not do things the way you would do them at your home practice – and not being frightened by that. We are called upon to care for patients and their problems that might routinely be cared for by specialists at home – we must, as expedition medics, be trained as we are the only option in the middle of nowhere.
Any courses/conferences you’ve found useful during your career?
The Fellowship of the Academy of Wilderness Medicine at the WMS and the Diploma in Mountain Medicine (DiMM) are great ways to validate your education outside the “normal” path of medicine. (See also the Adventure Medic review of the DiMM for more information.)
When you are not in a tent in Nepal, what kind of things do you like to do?
I love to ice climb. Frequently on Everest it’s sunny and warm and the ice is sticky in base camp, making for great practice climbs that might be too cold for my fingers and toes at home, ironically. At home I trail run and hike as much as I can with dogs and friends.
If you could change anything about your career what would it be?
I am so darned lucky – I have the best job in the world. I tell my boss that all the time. I went to job heaven and intend to stay there as long as I can!
Who do you admire in the field?
Who don’t I admire? There are so many folks who guided me as an early enthusiast. Buddha Basnyat is still one of my favourites. What an inspiring man.
Which 5 items do you never travel without?
- A bar of special Lush soap that can be used as shampoo, soap, laundry detergent and never leaks in my pack.
- A microfiber towel
- A smartphone. Not for the cell connectivity, but for all the textbooks and medical references that I have on it. And the flashlight – my cellphone has gotten me back to my tent in the dark more times than I can count
- A solar charger
- My mala beads from the Tengboche monastery
What kinds of adventures are in the pipeline next?
I’m hoping for Bhutan in September, and a NZ living experiment in the next year.
What advice would you give to those starting out in expedition/adventure medicine?
Stick with it. I can’t tell you how many people earnestly tell me they want to help me do this or that. They are well intended but 99% flake out and I never hear from them again. Stay with it!
What do you look for in potential Everest ER doctors?
We recruit from those who have demonstrated their dedication to the mission by serving a season at Manang or Pheriche HRA clinics. They are pre-tested for ability to live in austere conditions and practice real mountain medicine. And they must also be good camp cats, not get too grumpy when eating dahl bhat for the 109th day in a row!