The Trail to Mount Everest
Practicing Medicine at the
World’s Highest Hospital
Chapter 1
Background on Nepal
Nepal is a “developing” country with the same approximate size (56,136 square miles) and shape as Tennessee. It is bordered to the north by Tibet (China) and on the east, west and south by India. Divided into three geographical regions, the southern Terai plain is the agricultural breadbasket of the country. The central hill country, where Kathmandu is located, contains splendid terraces for growing rice during and after the summer monsoons. Finally, the majestic Himalayas occupy the sparsely populated northern tier of the kingdom. Eight of the ten highest mountain peaks in the world are located in Nepal. This youngest of the earth’s major mountain ranges is changing rapidly in geological terms as the Indian tectonic plate continues to subduct beneath the Eurasian plate. The 29,035-foot (5,050 meters) summit of Mt. Everest was once the bottom of the prehistoric Tethys Sea. Fossils can be found on the slopes of Everest. The summit of Everest is moving to the northeast at an incredible rate of 6 cm per year.
Nepal was a closed culture until the middle of the 20th century. The country was the product of the consolidation of several kingdoms during the late 1700s. In 1846, a feudal dynasty was created maintaining the original bloodline as puppet kings. In 1950, the puppet king Tribhuvan, escaped Nepal to India. India had just obtained its independence and both India and China cast covetous eyes at Nepal. The control of Nepal by the Ranas (of the feudal dynasty) was overthrown with the assistance of India and in 1951, King Tribhuvan was reinstalled on the throne. Tribhuvan was very wise. Even though it meant abandoning the policy of isolation, he immediately encouraged foreign nations to set up embassies in Kathmandu legitimizing Nepal in international eyes. Simultaneously, Tibet fell under Communist China’s control and access to Mt. Everest was cut off from the north, the route of Mallory and Irvine and other early Everest expeditions. That left newly opened Nepal as the only way to access the tallest of the world’s mountains. The successful summitting of Mt. Everest by Sir Edmund Hillary and Tenzing Norgay Sherpa on 29 May 1953 eventually opened the floodgates for climbers and trekkers who wanted to come to Nepal. Now tourism accounts for about 20% of the gross national product.
With a population of over 25,000,000 people, the Nepalese are expanding their numbers at about 2.5% per year. That, in spite of an incredibly high infant mortality rate of 102/1,000 or over 10%.
The caste system, although officially illegal, remains well entrenched in the Nepalese society. This system relegates members of the Nepalese society into very rigid levels based mostly on the type of work performed by members of the castes. Brahmans are the priest caste; Chhetris make up the warrior caste; Vaisyas are the merchants and artisans and Sudras are the farmers. The caste system is reflective of the influence of India. The various groups seem to co-exist quite well together. It remains difficult for a member of a lower caste to ascend the chain and work in a profession that is in the realm of a higher caste. Change is very slow in Nepal.
Hindus comprise 85% of the religious population with Buddhists making up 8% and Muslims at about 4%. The Hindus and Buddhists have amalgamated to some degree and almost all temples and shrines are replete with symbols of both religions. The country celebrates both Hindu and Buddhist religious holidays.
While there is no compulsory education, 4 out of 5 children attend some primary school and almost 1 of 3 goes to secondary school. The literacy rate is 35-40% with males at 52% and females at 18%.
The life expectancy for a man is 54 years and for a woman 52 years. The shorter life span for women is based on the high maternal death rate associated with the lack of readily available pre-natal care.
The per capita income is about $300 per person or equivalent to that of Haiti making Nepal one of the poorest countries in the world. The work force is 80% in agriculture, 11% in the service fields and 3% in industry. Although outright starvation is rare, undernourishment is very common, especially in the western regions. Since agriculture is the predominant form of “employment” many families practice subsistence farming.
The Nepalese are dressed in clean though relatively plain clothing. They are extremely friendly and scrupulously honest. Unfortunately, there are a number of beggars, at least in the Thamel region of Kathmandu where the tourists tend to congregate. There are also Sadhus who are professional beggars and who are easily identified by their dress.
The famous Gurkha soldiers, immortalized by Rudyard Kipling, are Nepalese. British forces, after assuming control of India, attempted to invade Nepal but were repelled by the legendary Gurkhas. After several failed attempts, the British agreed not to invade Nepal if the Gurkhas would serve in the British Army stationed in India to preserve the peace. It worked. Feared for their abilities with the knife, the Gurkha legend was born.
You may recall that about two years ago, there was a mass murder of the royal family in Kathmandu. Although it is impossible to know exactly what happened, one of the sons of the King of Nepal allegedly requested permission from his father to marry the woman of his choice in a culture where arranged marriage is the custom. The son already had someone in mind. Permission was denied as the woman in question did not meet the standards of the king nor fulfill the cultural requirements (wrong caste). The son, allegedly high on drugs, killed every member of the royal family present in the palace that night—save one of his sisters. And she has since died in a helicopter crash. The crazed son was himself killed although it is not clear as to whether he committed suicide or was killed by one of the palace guards. Eight of the ten royal family members were killed. The brother of the king was away in another area of Nepal with his wife. He ultimately assumed the throne and is considered by many Nepalese to be a capable administrator.
Even the American media have picked up on the Maoist insurgency in Nepal. Starting in early 1996, when Sue and I first trekked in Nepal, the fiercely anti-monarchist Nepalese communists have been attempting to disrupt and overthrow the constitutional monarchy. The Maoists are more influential in the northern and western parts of Nepal, however they have spread to the Kathmandu area and beyond. They flourish in a land where poverty is rampant. Many impoverished Nepalese look to the Maoists as promise after promise from the current government is broken. Maoist activity has extended into the Khumbu area of Nepal where I will be serving but not to any great extent. Save for the bombing of the airport control tower at Lukla where I will land to start the trek in to Pheriche.
Many of the physicians and the non-physician members of the Board of Directors of the Himalayan Rescue Association clearly feel that democracy currently is not a viable form of government for Nepal. Until such time as the population becomes educated and more sophisticated, democracy cannot flourish. Corruption and graft are a way of life in the Nepalese government. Will the Maoists prevail? It is not known at this time. But when you are trying to sway a population against the background of graft and corruption, it is understandable why the movement has succeeded. What is known is that there is now a cease-fire that started in early February of this year and seems to be holding.
The new king recently dismissed the entire government and reappointed a cabinet to his own liking. Although those appointed are not popular, at least they have expertise in the fields that they will administer.
The Solu Khumbu region of Nepal includes the 9,000-foot vertical approach to Mt. Everest from Lukla. The indigenous population is of the Sherpa culture that migrated from Tibet some 500-700 years ago. Strongly Buddhist in origin, they entrenched themselves in the highlands of the Himalayas and were able to carve out subsistence living. With the advent of tourism, many of them have become wealthy by Nepalese standards as they cater to the needs of the trekkers and climbers who visit the region during the two trekking seasons each year.
For those geographically inclined, the approximate latitude and longitude of Mt. Everest are 27 degrees and 59 minutes North and 85 degrees 55 minutes East. That corresponds to a latitude that runs through Tampa Bay, Florida.