Post Monsoon (Autumn) 2008

The voluntees this season were Drs Michelle Delap & Susan Hinsley, both from the UK.

KATHMANDU

Susan arrived on the 2nd September and Michelle on the 3rd.  We stayed at the Marshyandi Hotel in Thamel which was convenient and comfortable, having air conditioning and en suite facilities.   Whilst in Kathmandu we had to extend our visas as we were only able to purchase a 90 day visa at the airport.  Unfortunately our stay was extended because of the need to register with the Nepalese Medical Counsel requiring an interview which could only be done on the 7th.  We took the opportunity to visit Nepal International Clinic and Ciwec Clinic, both of which were generous with there time, advice and support. 

KATHMANDU TO MACHERMO AND GETTING STARTED

In view that the post was to open mid September and wanting to avoid getting altitude sickness etc we planned for a 6-7 day walk in.  On average it cost $15-$20 per day on food and lodgings .  During the trek the weather was good until we arrived in Machermo.  It seemed the monsoon was taking a long time to end and so the last 2 weeks in September were spent in rain and cloud.  We completed a drugs inventory and set the clinic up.  We also attempted to clean the post.  Being closed for 3 months at a time considerable dust builds up and everything was coated. 

 The local committee had decided that the porters shelter would not open for another week.  There were also very few tourists passing through.  In this time we visited Gokyo and commenced discussions with Mr Sharma of the need for a porters shelter in Gokyo .

Having completed the drugs inventory it was clear we were short on some medical supplies, especially antibiotics.  As the opening of the post was delayed we took the opportunity to return to Kunde Hospital and Dr Kami very kindly gave us much needed medical supplies free of charge.

DURING THE SEASON

We officially opened on the 26th of September.  It was a busy but successful season, a total of 223 patients were seen, which exceeded previous seasons totals and also our drugs and stationery supplies.  The lodges were also frequently full, especially in Gokyo when people were often sleeping in the dining rooms and we even heard of someone sleeping in a cow barn.  Unfortunately it has also been a tragic season. As well as the 2 deaths discussed in the medical report, there was the Lukla aeroplane crash killing 18 people, and 12 people killed by drinking contaminated local spirits.

During the season 566 porters stayed in the porter shelter, which is the most of any season to date. Clearly it is providing a much needed facility, porters were even descending from Goyo to stay at the shelter when the was no accommodation available.

We had many visitors: firstly, on the 6th of October, we received a  visit from Austin Metivier, the Canadian Architect who designed the Rescue Post.  He was delighted to see the post built and functioning.  He attended our altitude talk and enjoyed it so much he attended on the 9th as well.

We would also like to thank World Expeditions who brought a PAC for Gokyo.  We were able to deliver this to Gokyo Resort along with a pulse oximeter and some emergency medications.

The doctors from Pheriche visited early in the season,  It was good to be able to meet them and get news from the Kumbu valley. They also supplied us with some much needed parenteral dexamethasone, oral dexamethasone and antibiotics without which we would have struggled.  Their donation of fresh coffee was also very much appreciated.

Additional thanks must go to Gerry (sorry we don’t have your last name) for his suture kit and also his efforts to secure a feature on the Rescue Post in the Australian Doctors magazine. Also thanks to all the trekkers who donated medical supplies which were all used during the season and to Val Pitkethley who wined and dined us and kept us sane.

We started the daily altitude talks on the 26th September.  In total 1205 attended, 1076 tourists and 129 Nepalese.  We shared the talk and structured it around the existing presentation boards. It was well received and we were pleased with the frequent comments that it was easily accessible to non medics.  We felt it was important that the emphasis of the talk was to avoid AMS, adhere to the recommended ascent profile and not to ascend with symptoms.  Hence a lot of trekkers took an unplanned rest day in Machermo.  After the talk the oxygen saturation measurements were as ever very popular. 

The questionnaire on cough was completed.  We hope that the compilation of results will provide some useful statistics.

Although the season has been very busy there were quiet times especially at the start and end of the season.  During this time we found it important to have some light entertainment.  The purchase of the table tennis set was probably the best buy.  The dining table has now a duel role as table tennis table.  This was both entertaining to watch as well as keeping you warm when you played.  As the table tennis set only cost 85NR it was great value for money but the bats could do with being upgraded.  Another favourite time of day was 5pm after the talk, when the fire went on and it was time for milk tea and snakes and ladders.  We marked the week by making Friday night Black Adder night and have left the complete series on DVD along with Motor Cycle Diaries and Himalaya.

MERCHANDISE

We managed to sell most of the promotional merchandise.  Most of the T shirt were sold and we would have sold more especially if there were more small logo, red was a favourite colour and we even sold the the red sample shirt that was stapled to the wall. More mid sizes 38-42 would have also sold.  All badges and first aid books were also sold.

HOUSEKEEPING

Throughout the season we have been very well looked after by Chewang and Kancha.  Kancha constantly produced a very high standard of meals and considering the limited ingredients, we had a constantly changing menu.  Despite our best efforts we could never quite manage the 3 portions he provided for us.  Clearly a high standard of hygiene was maintained as we were not unwell as long a we ate at the Rescue Post.  Special commendation for going above and beyond the call of duty must also be given for bringing us morning milk tea in bed – a harrowing sight at the best of times.

Chhewang was always available and keen to help.  He was always very professional and respectful. With his wealth of experience, his knowledge of the local area, people and politics, we would not have managed without him. His constant good humour makes him a pleasure to work with.

At the beginning of the season Chhewang and Kancha kitted out the wash room which now has a shower stool and is lined for privacy and has drainage. The sun roof keeps it relatively warm and makes washing much easier.  Unfortunately the camp shower bag has suffered cold fatigue and now leaks.  It was effective however and we would recommend it is replaced.

MEDICAL STATISTICS

  • Total number of  patients seen 223
  • Broken down to Trekkers 109 (48.9%), Porters 74 (33.2%), Locals 40 (17.9%)
  • There were a total of 13 helicopter evacuations and 1 death due to HAPE.
  • The altitude related consultations were as follows :AMS- 52,HAPE -14, HACE – 1
  • Total of 13 overnight stays – 11 of which were over a 22 day period.  There were 13 Helicopter evacuations that were initiated by ourselves, and a further 3 helicopter evacuations from Machermo which were organized privately: no medical advice from the Rescue post was requested. 

With the large volume of tourists and subsequent over crowding at the tea houses viral URTI were common throughout the season with bacterial respiratory tract infections becoming more common from November onward.

It was also noted that the average age of trekkers has increased, and with that their co-morbidities.  Many not knowing their regular medications and some ceasing all medications prior to trekking.   There were also several incidences of poor pre-trekking counselling.  We were surprised how many people were  taking warfarin and had current histories of paroxysmal atrial fibrillation (some of which were unstable at sea level).  Typically there was an unrealistic expectation as to the service that could be provided from the rescue post.  It was also commonly believed that insurance companies would pay up front for a helicopter  and now that it costs $5600, many did not have sufficient funds on their credit cards.

SUMMARY

It has been the busiest season to date and despite some tragedy there have been some very positive outcomes.  The post continues to provide much needed shelter and to run smoothly with the local committee’s management.  The ongoing education of porters is still a priority as is the provision of affordable health care.  Trekkers have also been enthusiastic in their support and have been very grateful for the Post’s presence. We are pleased to be able to report that with the increased business we have managed to raise record funds  hence securing the continuation of the post for the next season.

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