Doing High Altitude Research in the Himalayas
Correspondence Address :
Dr. P.Ravi Shankar, KIST Medical College, Imadol, Lalitpur, Nepal. E-mail: firstname.lastname@example.org
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Pheriche, a small hamlet is an important settlement on the trekking route to the Everest Base Camp (EBC) in the Khumbu region of Nepal. The settlement is the location of the Himalayan Rescue Association (HRA) clinic which was started way back in 1973. Today the clinic is well equipped and handles mainly altitude related illnesses. Oxygen concentrators, Gamow bags, huge solar panels and a windmill to provide electricity and a satellite phone are the main facilities.
We were staying in Pheriche for over a month. We were a multinational team of doctors, nurses, echo technicians and physician assistants conducting a clinical trial in the khumbu region. The team had members from Nepal, Indians working in Nepal, the United States and the United Kingdom. The Nepalese members were from the Mountain Medicine Society of Nepal (MMSN). Dr. Jenny Hargrove from the Stanford University in the States was the team leader. The study was approved by the Institutional Review board of the Stanford University and the Nepal Health Research council. Dr. Buddha Basnyat of Nepal was the principle investigators and we were acting as study coordinators.
It is an ascent of over 700 m from Pheriche to Lobuche and certain trekkers break the journey at Dughla. There is however, only one small lodge at Dughla and most trekkers continue straight to Lobuche. The Khumbu region with an average altitude of around 3400 m pushes trekkers to their limits and altitude sickness is not uncommon. High altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) are occasionally seen. These days with better medical facilities and helicopter evacuation the mortality has decreased. Doctors have also learned to better manage high altitude problems. We were studying whether the prophylactic use of acetazolamide can prevent or reduce the incidence of HAPE.
We divided ourselves into two teams, one based at Pheriche and the other at Lobuche and the teams would swap after a fortnight. The volunteers for the trial were trekkers who were going towards Kala Pathar (a rock which offers a splendid view of Everest) and/or Everest Base Camp (EBC). The trekkers were explained the objectives of the study and were invited to participate. The risks and benefits of participating were explained and written informed consent obtained.
We did a Lake Louise scoring at Pheriche and again at Lobuche. A detailed examination of the lung fields and pulse oximetry was carried out. The lung fields and the heart were scanned using portable ultrasound scanners. Comet sign in the lung was taken as an early indication of fluid collection and the mean pulmonary artery pressure was measured as a wedge pressure. The study was approved by the Nepal Health Research Council and the Institutional Review Board of Stanford University in California, United States. The study was a double-blind, randomized clinical trial and there were two groups. One group received a sugar pill (placebo) while the other was put on acetazolamide. The drugs were in blister packs and the strength of the tablet was 250 mg for acetazolamide. We planned to have around 150 volunteers in each group. The data would be collected and then analyzed against a master list.
We flew into Lukla, a spectacular airport carved out of a hillside at around 2800 m. The airport was originally constructed by Sir Edmund Hillaryâ€™s Himalayan Trust to supply material for the building of the Khunde hospital. The runway is only around 150 m long and one end is around 50 m higher than the other. During the peak
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