Spring 2007 Report

spring 2007 team

Liz and Patrick arrived at the clinic on April 14th. We had prearranged for Chhewang to book our flights to Lukla as we only had 1 day in KTM and he left the tickets at the hotel for us. We arrived in Lukla at the start of a 5 day porters strike for a 600Rs minimum wage but managed to get a porter (gave him the 600Rs/day for going up, but 500 for the return trip with no load).

This spring season was particularly quiet due to the porter strike, which resulted in about many groups switching to Annapurna/Langtang regions. John and Liz took turns being at the clinic – we each went away trekking for 10 days – then John finished earlier, since he’d started earlier.

It’s essential to bring lots of things to do. There’s a small but good book selection here (including Nepali language books) and a DVD player – you can buy cheap DVDs in KTM.

Next spring season we suggest starting mid March and finishing mid May to fit in with the trekking season better. A lot of trekking groups were already near the end of their trips when the clinic opened.

Fortunately you can walk up the ridge either side of Machermo for 1-2 hrs and still be within sight of the clinic (Chhewang waved a red bucket if we were needed). A pair of cheap walkie talkies would be liberating so you could go further.

meeting with a yakWe saw 65 patients in all (over nearly 8 weeks); 22 trekkers and 43 Nepalis. Only 1 serious patient, a Nepali, 1 moderately serious trekker, and no helicopter evacuations.

Approx 400 people attended the AMS lecture and we received a lot of donations, including a very generous one of US$100. We offered to test O2% sats at the end of each lecture for 100Rs donation, which was popular.

Liz made a set of flip charts like HRA uses, as she found this easier than just using the whiteboard, hope you find them useful. The order is a bit different than in Nick’s presentation but covers the same info. (The edges may need strengthening with sellotape please.)

Chhewang SherpaWe went round the 6 lodges about 2pm each day to invite trekkers to the lecture and Pat made some colourful notices to put up at each lodge (they say “during the trekking season” so they will work for autumn too, if they’re still up).     

Excellent food was provided by Kancha, Mila’s brother. He wouldn’t let us assist in the kitchen with food prep or washing up. Both he and Chhewang were good cheerful company.

Liz brought a solar shower bag which worked well – when it was sunny – otherwise you can grab a LITTLE hot water from the kitchen (which has to be heated by kerosene cooker) or go to one of the lodges for a 200Rs shower.

Many thanks to Kancha and Chhewang for their help and company. It was a great opportunity to spend some time in a small Nepali community

Clinical cases

lecture on altitude illnessThis was a very quiet season, though plenty of trekkers attended the altitude lectures and, as can be seen from the cases below, lives were saved:

Case no 1: pneumonia + dehydration + query early septicaemia

This 32 year old cook was carried down from Goyko, arriving at the clinic at 1940hrs. Limited history due to his poor condition. Unwell 3-4 days with cough, fever, left sided pleuritic chest pain. Not passed urine for at least 24hrs.

Examination: pale, sweaty, RR 32, HR 104, BP 90/60, O2 sats 89% on air; clinical signs of left basal consolidation.

Tx: oral fluids + co-amoxiclav initially + O2 via concentrator.

He deteriorated about 2 hours later; desaturating to 73% whilst on the O2 concentrator. General condition poor. Unable to tolerate oral fluids. IV fluids were started + IV benzylpen (the only IV antibiotic available).

He was monitored through the night; condition generally improving, but periods of desaturation down to 73% and occasional, very brief episodes of cardiac irregularity.

At 0730 hrs the following day (whilst arranging transport to Khunde), he became extremely ill; RR 52/min, no radial pulse, sats 64% on concentrator. Neck and peripheral veins still flat despite 3 litres IV fluids overnight.

Good improvement when transferred to cylinder oxygen at 8 litres/min.

Options were now limited. On the one hand, he was really not stable enough to carry down to Khunde, but the doctors were now relying on limited cylinder oxygen. Helicopter was discussed with offer to pay, but his employer and work colleagues declined; preferring to carry him down with the oxygen cylinder.

Dr Apps accompanied him to about 3700m when his condition improved greatly; he started to maintain good sats on air, was fully conscious and able to eat & drink. He has since made good progress, but is likely to take 2-3 months to fully recover.

Case no 2: HAPE

40 year old Swiss man who became breathless and very fatigued whilst trekking from Machermo to ChoLa. Despite him looking pretty well and with sats of 80%, although RR of 30/min, he had bilateral creps to halfway up his back. LLS = 9.

He responded well to oxygen, salbutamol and nifedipine. He had already commenced Diamox on his way down to the clinic.

He refused evacuation and also refused to stay overnight at the clinic for continuing treatment. After 3 hrs he left to slowly walk down to Phortse Tenga with his guide. He was supplied with 5 days of nifedipine and was strongly advised that he should not re-ascend unless medically cleared at Khunde or Pheriche. He was intending to go to EBC and then climb Island Peak. Nifedipine prophylaxis was discussed for future high altitude trips.

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