Autumn 2006 Report

Dr Mathew Morgan and I were the lucky two to be chosen to run the post. We both live and work in Cardiff and Drs Nick and Emma Mason kindly invited us around for dinner a few times to discuss the posting, problems we might encounter and the amazing culture shock to come! As a result we felt confident by the time we left for Heathrow, on September 29th.

That was an incredibly busy day! We had contacted the BBC for an interview to highlight the work of IPPG. We ended up with national coverage as we did television and radio interviews. We also found the project reported on the internet and cefax! We hope that exposure shines more light on the IPPG. (These media interviews are a good idea for future volunteers! ed).

Getting to Lukla was a bit of a challenge but we arrived at Machermo on 6th of October and spent the night in the new rescue post. It took just twelve hours for us to get stuck into the action when we were asked to attend a German lady with HACE. Unable to produce any evidence of insurance or a Visa card, the Helicopter refused to fly which necessitated an evacuation by foot. I provided the medical escort as porters carried the lady on their backs down to Phortse Tenga the same day, and over the Mong-la the next morning. From the pass (which thankfully did not re-precipitate her symptoms), she was well enough to walk to Namche, where she made a rapid and full recovery. A baptism of fire for sure! During my day away from Machermo with that patient, Matt had needed to evacuate a severely unwell man with HAPE who thankfully had the means to pay for a helicopter. All this within 48 hours of arriving! What were we in for in the weeks to come?!

We were fortunate enough to be present for the official opening ceremony on the 10th of October, which Doug Scott and Dr Jim Duff attended. Lamas and Sherpas in traditional dress performed a colourful ceremony that felt meaningful to them and not just performed on behalf of tipping trekkers.

The next few weeks we settled into a routine; breakfast, seeing a few patients, then after lunch, going round all the lodges in the village to introduce ourselves to the trekkers and let them know about the altitude talk in the afternoon at 3pm every day.

The sunroom at the rescue post is excellent but unfortunately as the sun is lost to the post behind the southern bluff at around 14:30 everyday, it becomes cold during the talk at times, and particularly on cloudy overcast days.

Mathew and I developed a very efficient system of consulting patients during the season. We would see the patients together, one performing the consultation and examination, while the other acted as scribe. Due to the amount of duplicate paperwork that is necessary during the consultations, this proved extremely effective. It also allowed us to discuss patients together and to expand on the consultation with the patient without having to go through the whole history with the patient again unnecessarily. We believe that the patients also liked this system and were pleased and comfortable with it.

The vast majority of our work consisted of routine coughs and colds, the occasional gastroenteritis, and lower respiratory tract infections. We did see one severe pneumonia patient who was found by her porter on the side of the mountain having suffered a hypoxic collapse! Her O2 sats refused to climb from 39% despite desperate attempts to warm her hands, as surely the pulse-oximeter could not be reading correctly. Unfortunately, it was! Thankfully the solar panels were working flawlessly and we always had over 900W stored which allowed us to keep her on the oxygen condenser all night. Her friend, also needed evacuation, was on the oxygen cylinder having given herself severe AMS through her unfortunate fondness for Nitrazepam and Gin! An excellent combination at altitude I’m sure you agree!

During the season we evacuated seven patients with six helicopters. We held the policy that if someone could walk out, they should. There were occasions where the weather was too bad, or it was too late in the day for helicopters to fly that we decided the best policy was to descend on foot with medical escort. This happened on about three occasions.

We had a medical student for the first three weeks of the season, Sunil Sharma from Imperial College London. He was marvellous company and good fun to have around. I think he learnt a lot from his placement. We did drop him in the deep-end a bit by giving him a viva on high altitude physiology on the way up to Namche, which made him light-headed and he needed to sit down and have a kit-kat to recover! We always made him see his own patients and come up with a differential list and a treatment plan. This intimidated him at first but he soon grew into the role and was much more adept as the weeks passed. He gave the altitude talk one day towards the end of his placement and he did very well impressing us both. We wish him all the luck in the future.

Our time at the post was made all the more comfortable by the presence of a Maila our cook. Although his ingredients were limited, through no fault of his own, he managed to produce a vast array of foods that kept us fed and happy for the whole trip. We found the cauliflower, tuna, egg and chilly pizza especially interesting!

The porter shelter seemed to work well on many levels. The money was collected by Maila or Chhewang and records kept of who stayed and for which company they worked. This was entirely independent of the doctors.

The one major problem at the rescue post is the lack of heating. Not such a problem during October, but during November and December it became an issue. Initially the doctors were eating their evening meals in the sunroom but it soon became too cold to do this and we quickly moved in to the kitchen to eat with Chhewang and Maila. This was an excellent move as a team building exercise, as we all then spent most nights playing cards, and a home-made snakes and ladders game! It allowed us to break down cultural barriers, and ensured that we all got to know each other very much better than we would otherwise have done. The bedrooms were also extremely cold. We found it quite amusing that we had ice on the outside of our sleeping bags in the mornings, and just accepted it as part of the experience, but I fear that future doctors may not be quite so accepting of such conditions! (A yak dung stove and paraffin heater are now installed. ed.)

In conclusion, we had a fantastic season. We were all very lucky in that we all got on so well. We feel that we established a good relationship with the villagers and were made very welcome in return. It was an experience that I will always feel lucky to have had, and look forward to the next opportunity to occupy the post.

Dr David Gwynne

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