High Alert

The 12th Mountain Medicine World Congress is being held in Kathmandu 21-24 November, with more than 400 delegates from over 30 countries taking part.

The biennial conference is being organised by the International Society for Mountain Medicine (ISMM) together with the Himalayan Rescue Association (HRA) and the Mountain Medicine Society of Nepal.

The Congress will continue to focus on science and research and offer a comprehensive overview of ongoing topics of interest in mountain medicine, including emergency mountain medicine.

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Going to great heights to prevent altitude illness, Peter Hackett

Trekkers with the trots, David R Shlim

Located in the Central Himalaya with some of the highest terrain in the world, and a popular destination for mountaineers and trekkers from all over the world, Nepal is an ideal venue for the Congress.

Nepali climbers have accompanied expeditions for many decades to the world’s highest mountains not just in Nepal, but all over the world. In addition, and increasing number of young Nepalis are discovering their own country, and can be found in large numbers on trekking trails that used to be frequented by foreigners.

ON A HIGH: The inaugural session of the 12th Mountain Medicine World Congress in Kathmandu on Wednesday. More than 200 delegates from 30 countries are taking part. Photo: NAVIN BHATT

Nepal also has a long history of research in mountain medicine starting with the Silver Hut  studies in the early 1960s, one of the first to look at the effect of high altitude on the human physiology. The Sherpa people are probably the most studied, breath-analysed and blood-taken community in the world, as scientists try to find out how their bodies have evolved to high altitude.

Even today, many Himalayan expeditions have medical research components, like the study of two mountaineers who were on Mt Everest this spring, while their twins stayed at sea level. The goal was to study possible changes in their gene expression.  

Local organisers of the Kathmandu conference this week are mostly young Nepali doctors of the Mountain Medicine Society of Nepal (MMSN) which is dedicated to keeping the Himalaya safe by researching and increasing awareness of mountain medicine. They will be presenting findings on altitude illness, cold, avalanche hazards, search and rescue, exposure to ultraviolet radiation, etc. The conference has offered 80 scholarships for young Nepali doctors to attend the meeting with support from Maniraj Neupane, an internal medicine intern in Pittsburgh.

The Himalayan Rescue Association has been a pioneer in mountain medicine in the Himalaya for almost 40 years, with its clinics in Pheriche and other popular trekking and mountaineering routes.

Among the speakers at the conference are Peter Hackett who has done pioneering research into mountain medicine as medical director at the HRA, and David Shlim who has studied traveller’s diarrhoea.

At Altitude

As trekkers, mountaineers and other visitors to the high mountains climb higher, they can be affected by altitude sickness especially in its life-threatening forms like high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE).

The initial symptoms of acute mountain sickness (headache and nausea) are warning signs that need to be heeded by descending immediately. Not heeding the signs means the lungs start filling up with water, and excessive brain swelling at altitude or HACE may lead to psychosis, violent behaviour, and eventual death.

The Himalayan range, which includes 14 peaks above 8,000m, and begins where the European Alps reach the highest point. Hypoxia (lack of oxygen) stress that climbers feel in the Himalaya is much greater and therefore much more medically significant than in the Alps or perhaps even any other mountain range in the world.

In his inaugural keynote to the Congress in Kathmandu on Wednesday, Peter Hackett reminded the audience that the best antidote to altitude illness is still to take the patient down while administering bottled oxygen.

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