Sam Covins / Medical Student / Warwick University UK
This month Adventure Medic hears from Sam Covins, third year medical student at the University of Warwick, about a student-led research project to the Atlas Mountains. In the first of two articles, Sam, the group’s research coordinator, tells us of his experience conducting medical research at high altitude, and the enjoyment of Moroccan food and hospitality. We have followed this article up with a Q&A from Sam; handy for hints & tips on how to organise something similar for yourself.
In classical Greek mythology, Atlas was a Titan condemned by Zeus to hold up the sky for eternity as punishment for siding with his brother during the war against the Olympians. As the story goes, Atlas was later visited by the Greek hero, Perseus, who carried with him the severed head of the Gorgon, Medusa. When Atlas tried to drive Perseus away from the region, the hero held up the Gorgon’s head and turned the titan to stone, giving rise to the Atlas Mountains themselves.
At 4,167m, Mount Jbel Toubkal is the highest peak in the Atlas Mountains. We summited at 10:24am on Sunday the 13th of November. In 2 days we’d ascended over 3,5000m to reach the highest point in North Africa.
With more and more people across the world sojourning to high places for work or recreation, it has become increasingly important to understand the effects of travelling to altitude. In November 2016, we, a group of post-graduate medical students from the University of Warwick, completed a two-part research study to investigate the effects of hypoxia on human physiology during a graded ascent to high altitude.
We were looking to compare the physiological adaptations and changes that take place in the human body during exposure to the normobaric conditions of high altitude simulation, and the true hypobaric conditions of genuine high altitude. Phase I of the study (normobaric hypoxia) was conducted in a specially designed hypoxifying chamber at the School of Sport, Exercise and Rehabilitation Science at the University of Birmingham, under the supervision of the facility director, Dr Sam Lucas. Phase II (hypobaric hypoxia) was conducted during a 6-day expedition to the Atlas Mountains, with the support and guidance of our UK-based supervisor, Professor Chris Imray – an internationally renowned expert in the field of altitude research. Here’s a bit about how, and what, we did when hiking up a mountain.
What were we actually doing?
To study the physiological changes that take place with increasing levels of hypoxia, we performed a series of investigations at several predetermined altitudes that corresponded with key locations along our route of ascent to the summit of Mt. Toubkal. We conducted the exact same experimental protocols at 466m (Marrakech), 1,740m (Imlil), 3,207m (Refuge Toubkal) and 4,167m (Summit of Mt. Toubkal) during both phases of the study. At each altitude, we established a research circuit consisting of several stations at which different experimental protocols were performed. Cognitive and behavioural changes were assessed at Station 1 using laptop-based tests, and it was at this station that participants were also asked to complete their Lake Louise questionnaires to report any signs or symptoms of acute mountain sickness (AMS). Physiological measurements (including heart rate, blood pressure, respiratory rate, oxygen saturations and end-tidal CO2 values) were recorded at Station 2. Wrist and ankle circumference was measured to assess for any evidence of peripheral oedema, and thermal images were taken to analyse peripheral perfusion. Station 3 consisted of several visual function tests, including Snellen chart and Ischihara plate assessments, visual field testing and pupillary light reflex analysis. Respiratory function testing was performed at Station 4, both before and after a short exercise test, using a portable spirometer to analyse and record a variety of lung function parameters (including PEFR, FVC, FEV1). Continuous ECG monitoring was performed throughout the duration of the expedition using portable 3-lead ECG devices.
Day 1: Marrakech
We departed the UK on the morning of Thursday the 10th of November, arriving safely in Marrakech with no unexpected flight delays and with all of our luggage accounted for. As we made our way from the airport to the hostel, we could just about make out the snow-covered tops of the distant Atlas Mountains through the hazy Moroccan scrubland. After arrival and check-in at our destination, we headed into the city for lunch. The streets of Marrakech were a hive of activity, full of street vendors, juice sellers and snake charmers. The rest of the day was spent sightseeing and exploring the local souks, and after an evening meal of tagine and couscous in the Jemaa el-Fna, we headed back to the hostel for a briefing from our Expedition Leader, Kenneth Morrison. Kenneth had previously summited Mt. Toubkal in 2008 and was chosen from amongst our group to plan and coordinate the expedition logistics. In his briefing, Kenneth gave a detailed overview of the expedition schedule and itinerary, highlighting important times and locations for transfers and other arrangements. He gave an instructional talk on health and safety and introduced a ‘buddy system’ to encourage the expedition members to monitor and care of one another.
Days 2 & 3: into the mountains
The next day, we spent the morning conducting our first round of research experiments on the roof terrace of our hostel, much to the fascination of the other guests. With the research complete, we bid farewell to Marrakech and set off on our journey to the Atlas Mountains, later arriving at the village of Imlil. Here, we were greeted by our guides from Pathfinder Treks, a local Moroccan mountain guide agency that Kenneth had worked with during his previous ascent of Mt. Toubkal. The guides led us to a nearby mountaineering outlet where we equipped ourselves with mountain boots, crampons and gaiters in preparation for our ascent. After a short scenic walk through the mountain woodlands we arrived at Hotel Atlas in the village of Aroumd, where we spent the night.
After breakfast, we packed our bags, loaded the mules and set off on our trek through the rocky foothills of the Atlas Mountains. We eventually arrived at the settlement of Chamharouch, where we stopped for a short refreshment break before continuing our ascent. Upon reaching the snowline, the porters decided to abandon the mules and carry our baggage on foot. It was here that we first caught sight of the smoke rising from the chimneys of the Refuge Toubkal in the distance, and after an hour of trudging through the snow we finally arrived at our destination. After check-in, we made an immediate start with our experiments so that we could all get a good night’s sleep in anticipation of our early start to attempt the summit the next day.
Day 4: summit day
For logistical purposes, we decided to split the expedition team into two groups. Group 1, which included all 7 researchers carrying the research equipment, began their ascent at 6am in the dark, and were rewarded with the most spectacular sunrise over the mountain tops. Progress was steady with regular rest breaks. As our altitude increased, many of the group started to experience some mild symptoms of AMS, but nothing too serious to warrant an early descent back to the refuge. We therefore continued our relentless ascent until we reached the 4,000m checkpoint where we were greeted by a breathtaking panoramic view of the Sahara. At this point we could make out the distant figures of our Group 2 companions, who had left the refuge two hours later to allow the the first group of researchers time to establish a research base on the summit. After pausing to take in the sights, we continued our ascent along a narrow exposed ridge that paved the way to the summit.
Our arrival at 4,167m was celebrated with an exchange of hugs and handshakes followed by a series of obligatory summit photos. The view from the top was simply outstanding with visibility for miles in every direction. I remember the huge sense of relief of having finally made it. After taking the time to take it all in, we then set to work establishing our research base and promptly began our fourth round of experiments. We were soon joined at the summit by the members of Group 2 who were quickly circulated around each of the research stations. As the clouds started to roll in, the guides grew anxious and eventually insisted that we descend to avoid the worst of the weather. Fortunately, we were able to complete the majority of our research investigations in the time available and our study was not hampered by our premature descent. Having once again successfully navigated across the exposed snowy ridge, we continued our descent back to the refuge.
And home again.
In light of our successful summit attempt, and after a well-deserved lie in, the expedition team was in high spirits as they left the Refuge Toubkal and headed down towards Imlil. Tracing our footsteps along the route of ascent, we eventually arrived back in Aroumd where we were treated to lunch and Berber tea, courtesy of the guides. After lunch we continued our trek down to Imlil before boarding the minibus that was awaiting our arrival. A short car journey later and we were back in Marrakech where we spent the evening eating, drinking and recounting stories of our adventure. The next day we departed Morocco and returned home to the UK to begin the analysis and interpretation of our research results. Such an adventure.
We’re still in the process of analysing our data and preparing manuscripts for publication; I’ll keep you updated with the results of all of our hard work as soon as I can! Although it was a fairly stressful and time-consuming experience, I thoroughly enjoyed the entire experience, and I’m so proud of what we’ve achieved as a group. We loved it so much, we’re now in the very early stages of planning another expedition to the Monte Rosa massif already. So watch this space in case we’re looking or eager student participants soon…
Our follow-up Q&A article has now been published, showcasing how Sam organised his expedition and the ups & downs along the way: a great read, particularly if you’re considering doing something similar yourself.
Photos credited to expedition photographers Alasdair Anderson and Lara Dooley, with thanks.