The Trail to Mount Everest
Practicing Medicine at the
Worlds Highest Hospital
The Himalayan Rescue Association of Nepal
The Everest Memorial Trust
Created in 1973 the Himalayan Rescue Association (HRA) of Nepal is a non-profit, non-governmental organization with four missions.
1. To provide education to trekkers of all countries (and the porters of Nepal when we can) on the nature and prevention of Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) and the other medical problems that occur with trekkers in the High Himalaya.
2. To provide fee for service medical care to the trekkers for a variety of illnesses but particularly the life threatening complications of AMS, HACE and HAPE. It is the funds that are gathered from the trekkers that support the HRA.
3. To provide general medical care to the indigenous local Nepalese population and the porters who carry absolutely monstrous loads (up to 60 kg = 132 pounds) to unimaginable elevations (the Everest Base Camp is at 17,600 feet).
4. To conduct meaningful, ongoing research on altitude sickness.
The HRA was founded in 1973. Dr. John Skow, an American Peace Corps volunteer was completing his tenure in Nepal and decided to trek in the Solu Khumbu/Mt. Everest region before returning to America. He was astounded to learn that many western trekkers and Nepali porters were developing Acute Mountain Sickness and succumbing to the complications of high altitude cerebral edema and high altitude pulmonary edema. Upon his return to Kathmandu, his efforts resulted in gathering together representatives of the Nepal Ministry of Health, local Nepali doctors and representatives from the principle trekking companies. With the realization that trekking was a rapidly expanding industry in Nepal and that prevention of death due to Acute Mountain Sickness (AMS) was possible, the Himalayan Rescue Association was born on December 11, 1973.
The first physical structure for the Aid Post came from very humble beginnings. A yak hut (not yak herders hut). The dung was swept from the dirt floor and hay was stuffed in the windward wall to diminish the drafts from the less than balmy Himalayan breezes. A French volunteer nurse was the first HRA Health Care provider in 1974. Dr. Peter Hackett, the renowned high-altitude physiologist and physician, worked at Pheriche from 1975 through 1978. His research into the diagnosis and treatment of AMS pushed back the frontiers of knowledge into the causes and treatment of high altitude medical problems. Just as importantly, he was also instrumental in recruiting other physicians to serve at the Pheriche yak hut.
In 1974, the Japanese became interested in research into high altitude sickness and donated $50,000.00 to build the first formal Aid Post at Pheriche. Construction was started in 1975. Professor Y. Hayata of the Tokyo Medical College was instrumental in the Japanese interest.
The Everest Memorial Trust, based in the United Kingdom, made major improvements to the hospital starting in 1998. Over the past 5 years, the rock structure has doubled in size and has been reinforced with mortar in the cracks of the stones to keep the wind from blowing through the bedrooms. Solar panels and a wind generation system supply 220-volt AC electricity in small quantities. And there is a solar thermal heating system for water and to provide some heat for the structure. There is a shower as well. The average nighttime temperature in the bedrooms during the spring season runs about 20 degrees F (as it turned out, there were two consecutive nights in early March where the bedroom temperature was 30 degrees Celsius). There is now inside plumbing with a sit down toilet (instead of the traditional Charpi where one must squat), sink and shower. The EMT also installed a septic system and drain field. A spring from the nearby lateral moraine of the Khumbu glacier was tapped and water brought to the clinic cistern by underground pipe. This pipe did not thaw during the spring season last year meaning that water had to be transported from the spring by other means. The renovations were expensive considering that much of the material had to be transported to Pheriche by helicopter. The EMT invested nearly $100,000.00 in this project.
Located on the trail to the Mt. Everest Base Camp at 14,517.5 feet, Pheriche and its HRA facility, seemed to be the site where many cases of AMS that led to death either occurred or to where these cases were transported. It is the highest hospital in the world (defined as providing in-patient care). Sometime later, the British Embassy made initial contributions that allowed the construction of a second Aid Post at Manang. Manang is located on the Annapurna Ring, the most popular trek in Nepal, at about 11,000 feet. That aid post is also under the HRA umbrella.
An HRA headquarters office was also established in Kathmandu to coordinate the staffing and function of the two remote Aid Posts. Conveniently located in Thamel, in 1998, it was moved to its current location across the street from the Royal Palace. Here, trekkers can also come and receive free lectures concerning AMS and its prevention.
For the first time since the inception of the HRA, a new outpost is being established this year at the Everest Base Camp at 17,600 feet at the foot of the Khumbu icefall. Medical care will be offered as needed especially to the porters and Sherpas who may become ill in the very thin air after ascending too rapidly. Many Everest expeditions have their own physician but a significant percentage of these doctors have minimal if any high altitude medicine training or experience. Therefore it remains to be seen how many of the mountaineering groups will take advantage of the expertise at the HRA Aid Post at the Base Camp.
The HRA has done legendary work in the Himalayas. The Aid Posts/Clinics/Hospitals are appropriately equipped considering it is 5-10 days by yak train or porter to resupply them with medical equipment and the essentials for living at altitude. That is not to say that we will not encounter problems but considering the isolation from the rest of the world, the rudiments are there.
Two local Sherpas staff the clinic. One serves as the cook and the other who actually has acquired enough medical skills to see patients. Both have been with the HRA for nearly its entire 30-year existence. Additionally, a Nepali from the Kathmandu headquarters goes to the mountains with each cycle to manage the porters and yaks on the trek in and out. He is also the financial expert and knows a significant amount about the electrical and plumbing systems.
The physician staff is all volunteer and mostly from the Western countries. There have been at least two very dedicated American-trained Kathmandu physicians who have also donated time to the Aid Posts. Due to the somewhat austere and isolated circumstances, volunteer physicians are encouraged to bring their spouse or significant other with them as long as they are willing to work in some capacity around the clinic. And also to provide an element of warmth for the doctors. Physicians who donate their time must pay their own way to Kathmandu but are supported by the HRA regarding shelter and food for the duration of their stay. All the dahl bhat you can eat! And the living accommodations are a no sweat guarantee.
The aid posts operate during the two separate trekking seasons each year. The first is from about March 7th to May 10 and the second is from October 1st to December 15th. This year being the 50th anniversary of the first ascent of Mt. Everest by Sir Edmund Hillary, it is expected that there will be a significant increase in the traffic to the Everest Base Camp, especially in mid to late May. The anniversary date was 29 May 1953. We have been asked to keep the clinic open until the end of May to assist with any medical problems that attend this increased volume of trekkers.
This year we simultaneously celebrate the 30th anniversary of the HRA, the 40th anniversary of the first American ascent of Mt. Everest by Jim Whittaker, the 50th anniversary of the first ever ascent of Mt. Everest by Tenzing Norgay Sherpa and Sir Edmund Hillary, and the 25th anniversary of the first ascent of Mt. Everest, without oxygen, by Reinhold Messner and Peter Habeler.
One of the most frequently asked questions is What is the elevation of the Pheriche hospital? This is a difficult question without reliable GPS measurements and other sophisticated cartography techniques. Various maps give different elevations. The Nepa Map, produced in Nepal, lists the elevation at of Pheriche as 4,270 meters (14,010 feet). The HRA gives the elevation as 14,343 feet (4,371 meters). Finally, the Everest Memorial Trust lists the elevation as 14,600 feet (4,450 meters). The hospital is located in upper Pheriche so the current staff has chosen to designate the elevation of the facility as 14,517.5 feet (4,425 meters) that just happens to coincide with the halfway point between sea level and the top of Mt. Everest. But then, there is still discussion as to the actual elevation of the summit of Mt. Everest as the thickness of the snow cornice at the top of the world has not been accurately determined (if one considers that important). 
Himalayan Rescue Association ( +977-1-4440292, 4440293
Post Office Box 4944 E-mail email@example.com
Dhobichaur, Lazimpat Website: www.himalayanrescue.com
The Everest Memorial Trust (EMT) is a registered charity in England. The mission of the Trust is to undertake new environmental, health and education projects, initially with the Solu Khumbu region of northeastern Nepal but with aspirations to expand its activities throughout the country at a later date. Target areas for the Trust projects are the high mountain communities of the Himalayas, as befits a charity founded to commemorate all those climbers and Sherpas and porters who have died on the slopes of Mt. Everest since 1921.
The idea for the Trust originated from the organizers of the 1993 DHL British 40th Anniversary Everest Expedition, the first sponsored charity expedition, which saw Rebecca Stephens as the first British woman to summit Mt. Everest. Harry Taylor summited with her. This event ultimately raised $150,000 for the Sir Edmund Hillary Himalayan trust. This was also the first expedition to pay its climbing Sherpas to bring down old expedition oxygen bottles for the South Col and Lhotse Face as an environmental contribution. This idea germinated and has been repeated over the years since then by other expeditions. Now only a few old bottles of the original 1500 remain on the South Col.
Those behind the Trust, therefore, have considerable knowledge of the Solu Khumbu and the workings of the country of Nepal in general.
The current staff of the Pheriche Hospital owes a great debt to the Everest Memorial Trust for their efforts to improve the quality of life in the Solu Khumbu. It is our fervent hope that their assistance will continue and that their continued support will not wither. There are still many improvements that need to be made. Making these needed improvements may provide incentive for other talented physicians to brave the elements and spend a block of time at Pheriche working with trekkers, climbers, porters and the Sherpa culture. It may also motivate those interested in research to design viable and meaningful research projects and then come to the Pheriche laboratory to collect data.
There are notes and recommendations referable to EMT Pheriche Project 2000 listed at the website below.
Website: www.emt.org.uk This is a great website with pictures of the Pheriche Hospital during installation of the solar voltaic and wind turbine electrical generation system, the water system and the solar thermal ethylene glycol heating system. There are also some great pictures of the facility with its natural surroundings.
 Bowman, W.E.: The Ascent of Rum Doodle London: Arrow Books, 1956
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