More porters sick on Everest trail

Why was the 2023 spring season so dangerous for trekkers, mountaineers and their guides on Everest?

Rescue helicopter approaching the HRA Pheriche Aid Post. Photo: Konstantinos Sofikitis

Spring 2023 was the deadliest season on Mt Everest, with 17 climbers dead or missing on the world’s highest mountain. But the trail leading to the base of the mountain also saw record numbers of trekkers and porters falling sick due to altitude sickness.

An unexpectedly high number of people had to be treated at the Himalaya Rescue Association (HRA) aid post at Pheriche (4,300m) and at the Everest ER at Base Camp for HAPE (high altitude pulmonary edema). 

In an average year, the HRA aid post used to get only about 15 cases of HAPE, but this spring season alone there were an alarming 50 cases with clear-cut clinical diagnosis confirmed by field ultrasound detection of lung fluid. 

Only five of the 50 patients were foreign trekkers, the rest were Nepalis and mostly porters. Medical personnel in Pheriche are scratching their heads to figure out the reasons for this high patient load.

One reason is the post-Covid backlog of trekkers and mountaineers as Nepal’s climbing industry saw a surge on the 70th anniversary of the first ascent of Everest by Hillary and Tenzing. Many of the hikers and climbers said they were also drawn to Nepal by a series of adventure films about the Himalaya, including Nims Purja’s 14 Peaks: Nothing is Impossible.

high altitude pulmonary edema
Everest ER at Base Camp.

There was also a spurt in Indian trekkers and climbers, and one reason could be the Bollywood movie Uunchai starring Anupam Kher and Ambitabh Bachchan which was shot on location in the Khumbu and Manang last year.

There were 50 companies guiding nearly 500 clients on Mt Everest alone, with more expeditions on Lhotse, Ama Dablam, Nuptse and other peaks. More expeditions meant more guides and support staff. There were nearly 2,500 people in May living for up to three months in the tent city at Everest Base Camp.  

There has also been a steady shift to other ethnic groups working as guides and porters in the Himalaya. Instead of Sherpa, who are in all likelihood genetically adapted to high altitude, the Rai, Tamang, even Chetris and Brahmins are more susceptible to high altitude sickness. 

HAPE can be life-threatening as the lungs drown in fluid. Unlike acute mountain sickness (AMS), which is relatively benign and common in sojourners even at lower altitudes in the Khumbu HAPE is similar to high altitude cerebral edema (HACE) in which the brain itself becomes water-logged.  

The other reason for the dramatic increase in HAPE this season could be that there was a greater disregard (possibly due to lack of awareness) for the most important risk factor for altitude illness, the rate of ascent. Many porters may have spent just one night in Namche Bazar (3,440 m) instead of 2 nights on their ascent to Pheriche and higher. 

Many scientific studies have clearly shown that spending only one night in Namche Bazar dramatically increases the risk for altitude illness. Other reasons for HAPE predisposition could be colder temperatures this spring with heavier snowfall, which meant greater physical exertion at high altitude.

Whatever the reasons, this enormous increase in HAPE patients strained the resources of the HRA. Private clinics in the Khumbu region generally do not see these very sick, uninsured patients for free, so most of the 45 patients turned up at the HRA. 

“Many of the sick porters had no friends or support,” said HRA’s Gobi Bhasyal. “They were kept for at least night for observation with careful nursing care and oxygen from bottles or concentrators at the clinic.” 

Most were discharged after two days. None of the patients had health insurance and they had to rely on kind helicopter pilots who would give them a lift down to Lukla for free provided there was a western client who was paying to be rescued.  

“We not only had to look after the patients in the clinic but also find willing helicopter pilots who would allow the patient to piggy back on a paid ride,” said Thaneshwar Bhandari, HRA’s health assistant.

high altitude pulmonary edema
HRA Pheriche Aid Post.

Indeed, it is a tribute to the dedication of HRA staff that all 50 patients treated at the clinic this season recovered.

The high incidence of altitude sickness was also reflected in the rise in rescue helicopter traffic in the Khumbu this season. Heli medevacs are life saving for many patients where the most important treatment is descent. 

But helicopters were also being used indiscriminately for commercial purposes in the Khumbu for dubious indications, like for a patient with diarrhoea or just fatigue.  

There more than 50 daily helicopter flights in the Khumbu this season from 6AM to 6PM. This in turn had a detrimental effect on the wilderness experience for many trekkers, and could in the long term impact on future tourism prospects. 

This year’s Everest ER was staffed by physicians Andrew Nyberg, Sachin Subedi and Suraj Bhatta, and in Pheriche by Luke Apisa, Renata Bueno and Nishant Joshi. The HRA post in Manang had Craig Kutz, Catherine McBride and Shama Bhandari. Ken Zafren from Alaska has helped select volunteer doctors for almost 3 decades.

Buddha Basnyat, MD, is Medical Director of the Himalayan Rescue Association (HRA).