medex

Medex Newsletter, 19

November 2005

Introduction

 

Congratulations to the four Medex members summitted Cho Oyo as part of Roger McMorrow’s Expedition. This trip was organised in preparation for the CASE Everest attempt in 2007 and they were able to test many of their systems. Roger was trying his own oxygen re-breathing circuit and Nigel Hart set a record an altitude for the collection of an arterial blood gas. Piotr gave an excellent account of their antics at our well attended autumn meet at the Old Dungeon Ghyll.

 

At the ODG we had an excellent meeting panning out future trip and there was much enthusiasm for both the 2008 West Nepal Expedition and a return to Everest in 2010 via the North  Col. In addition to Everest we will also be climbing the 7,000m Lhakpa Ri which is both technically easy and superbly situated above the Rongbuk Glacier. Andy Grieve and Stephan Sanders will be heading up the research team on both the 2008 and the 2010 Expeditions.

 

After 3 yeas of planning our Antarctic Expedition is just around the corner. Our equipment is already in Tierra del Fuego and we fly out on New Years day for 7 weeks. More, very much more, on this will appear in later editions!

 

Future Expeditions

 

Antarctica 2006

From January 1st until February 20th we will be in Antarctica. We sail from Tierra del Fuego on board Skip Novak’s yacht Pelagic and head south across the Southern Ocean to the Antarctic Peninsula. Once within the shelter of the archipelago we will cruise as far south as ice permits. Along the way we will ski and climb whatever looks enticing. We hope to climb the stunning Mts Scott and Shakleton above the Lemaire Channel.

 

Pelagic will be our home for 6 weeks but our skipper will be able to drop us off for longer shore trips and traverses so we really have the best of both worlds. In addition to ski mountaineering we will also be diving and sea kayaking so the whole thing should be a magnificent adventure.

 

  

 

West Nepal 2008

This very unusual Expedition visits some of the remotest regions of Nepal as it threads its way westwards for 60 days along the spine of the Himalayas. Those with more limited time will be able to join and leave the route at various nodes along the way. Full details are on the www.medex.org.uk website. This prolonged mountain journey presents some exciting new challenges for our research team who will be looking much more at chronic acclimatisation rather than the more usual acute model.  

 

Everest and Lhakpa Ri 2010

The route up Everest via the North Col needs little introduction. We will be going  back to Everest sixteen years after our successful ascent from the South Col before we are all too old! Once again there will be a large research component to this Expedition and we hope to be able to invite a party of  trekkers, researchers and climbers in addition to those that have their eyes set on Everest itself. One very worthy objective is the 7,000m Lhakpa Ri which is pictured below. This peak gives is superbly situated with stunning views of Everest’s Kangshung Face. It is very high though apparently presents few technical difficulties.

 

 

We will be putting a full Expedition Prospectus on the Medex website in due course.

 

Meetings

 

WORLD CONGRESS OF MOUNTAIN AND WILDERNESS MEDICINE:
Scotland, Sept 27-Oct 1st  2007. This is the next World Congress and is sponsored by both the International Society of Mountain Medicine (ISMM) and the Wilderness Medical Society (WMS). Brownie Schoene from the USA is the Co-Chair from the WMS (he is their past president). Charles Clarke will head up the organising from the UK side. Various Medex members, as well as other altitude buffs, will also be involved. It should be a great conference so put the dates in your diaries now!

 

Mountain Medicine Course, Plas y Brenin. Fri 2nd – Sun 4th December 2005

See the web site ‘courses’ for a provisional time table, and email courseadmin@medex.org.uk to register interest. More details to follow soon! Medex members are welcome to attend the social functions but obviously must register if they want to participate in the course.

 

Altitude Symposium 30th November 2005, St. Catherine’s College, Oxford. Full details on the website. Organised by Medical Expeditions.

 

One Day Conference in the History of Altitude Medicine, December 5, 2005, we are organizing in the University of Manchester with guest speaker John West. Papers in the conference will deal with the history of hospitals at high- altitudes, sports medicine and human populations living at high- altitudes. Contact Jorge Lossio jorge.lossio@stud.man.ac.uk

 

 

Disaster Relief

 

Denzil Broadhurst and the Oldham Mountain Recue Team have been raising money for the Boxing Day Tsunami. Following on from an email he circulated via Medex earlier in the year he has now sent in this. “We raised £8,500 with the abseil, and the money went to a project in Sri Lanka being run by Keela (manufacturer of outdoor clothing - who  we have good links with). Keela have close links with Sri Lanka (relatives of the owners, plus a manufacturing site there).

<http://www.keela-outdoor.co.uk/pages/more-news.asp?news_id=22>

<http://www.keela-outdoor.co.uk/pages/more-news.asp?news_id=21>

 

 

Thanks to all those people who suggested contacts from my original email at the beginning of this year. Cheers, Denzil”

 

Old gear you don't plan to use - The Mountain Company and Cotswold are going to be shipping donations to Pakistan to help the people involved in the earthquake.

See: http://www.themountaincompany.co.uk/content/view/78/89/

 

RAPID – a first response search and rescue charity that operates in disaster areas is looking for some sympathetic doctors who may be able to give telephone advice to the paramedics attached to each rescue team. For almost a decade Peter Old has been lecturing on our Plas y Brenin course. In his other life he jets off, at a moments notice, with RAPID to far flung corners of the world to assist in the search and recovery of casualties after and natural disaster. Impressively he and his time were in Islamabad just 20 hours after the earthquake hit northern Pakistan this autumn. Peter provides medical cover for the search teams and would like a handful of names to ring on the rare occasion that he needs medical advice whilst in the midst of a natural disaster. Please contact me directly if you are willing and able to join me in providing this telephone support. simon@medex.org.uk

 

 

Social

Chamonix Skiing, 18th - 26th February 2006

 

Please come and join Michelle and Annabel for a week of skiing in the Chamonix area. Our party includes beginners to wanna-be powder hounds!

 

We will be staying at a small family run hotel, the Beausoleil, in Lavancher, half way between Chamonix and Argentiere. Bookings can be made directly on the web

http://www.hotelbeausoleilchamonix.com/beausoleilgb.htm.

 

Feel free to contact Michelle (mwdoc@doctors.org.uk) or Annabel (annabel@medex.org.uk).

 

Hyssington Summer BBQ 8th July 2006

By popular request the annual mid Wales is back! Everyone welcome to a relaxed BBQ weekend in Montgomeryshire. Camping available. Contact simon@medex.org.uk if you can make it.

Old Dungeon Ghyll in the English Lake District October 2006

October th 2006, Old Dungeon Ghyll Hotel, Lake District Weekend. This is the annual Medex event We normally arrive on the Friday night, spend Saturday on the hill with dinner in the evening.  B&B accommodation can be booked direct with the Hotel (tel: 015394 37272) and camping is available nearby.  If you want to attend the dinner on the Saturday evening this must be booked direct with Medex as places are limited.  A cheque for £30 will secure your place for dinner, made payable to Medex and sent to the Pinfold, Hyssington, Montgomery, Powys SY15 6AY

Pay either by cheque or direct bank transfer into the Medex account: contact simon@medex.org.uk for details. Unfortunately at present we do not accept credit cards. www.odg.co.uk/langdale

Medex Membership

A further gentle reminder to all those who have not yet re-joined Medex. The current membership period runs to December 31st 2008 and costs just £45. I have included at the end of this newsletter a list of all those who have already signed up and so, if your name is not on the list, your membership has expired. If you do wish to re-join then please drop us a line with a cheque or email us asking for the bank details for direct transfer.

Babies

This news is in from Roger and Sara McMorrow, “Just to let you know at 0615hrs on Monday 14th November my Daughter Aoife Claire McMorrow was born 4070g (9Lb) after 7hrs labour. She was OP but came out with a bit of a push! She was born at home, uneventfuly. We even had the Midwife putting more turf on the fire between contractions. Sara is in excellent health and the whole family are intending to come to PYB in November.” Roger

 

Greg Harris made this announcement on August 6thAs of 10 am Darwin time, last Thurday, Naomi & I are extremely gushingly proud parents of a little boy, Ariel Tomas Myer Harris.

 

Just over 3 kg (6 lb 11 oz in the old language) and really big hands and feet. I think he's going to be a big kid!Both he and Naomi are well, if a bit tired, but he's doing all the right things. I even think some of those wriggly movements look a bit like climbing up a chimney.....

 

Not surprisingly, I haven't yet really had a good look at the sleep data, Annabel! I think we could do a little (lack of) sleep study ourselves!! It will get done, I promise!!”

 

  

 

 

Richard Parris writes “All is well up in Manchester, Liz and I are now the proud parents of a boy called Daniel - he has spared us too many sleepless nights, we are occasionally very tired, frequently a little tired and once in awhile very rested. It has been great fun having the wee man, 13 weeks old already, the only hiccup was a little exploratory op aged 7 weeks for a possible torsion of his testicle that turned out to be an epididymitis. He has grown a lot and is now a big fat splodgy lump that coos a lot.

 

I was finally appointed after a years locum to a permanent consultancy at Bolton - the permanent appointment has made no difference to my life which is currently a very pleasant 3 1/2 day week and an occasional weekend. There is therefore plenty of time to attempt to pursue my running and to follow Altrincham - perhaps my major achievement has by default to be appointed or even assumed to be the official club Doctor, a longstanding ambition since the age of 10 and one of which I am very proud.”

 

People News

Nick and Emma Mason have been working out in Nepal. In previous Newsletters we have publicised the Machermo Rescue Post in Gokyo and I am delighted to be able to include this account of Nick and Emma’s experiences.

At the end of the MEDEX 2003 trip to Nepal I wrote in my journal, “I feel ill at ease about all the porters we used and their appalling lifestyle. I know that it is their job and that we are providing them with employment but I still remember with embarrassment and discomfort watching the porters descend towards Khote through the snow. Would that I could do something to help them.” It was therefore with some interest that Emma and I read an e-mail distributed through Medex announcing that the International Porter Protection Group were looking for a doctor to work at their Machermo Rescue Post in the Gokyo Valley of Nepal for the autumn season of 2005 . We had been planning a trip for the autumn and this seemed to fit in perfectly and after spending much of the last 5 years researching and teaching high altitude medicine and physiology it would be good to do some practical medicine again at altitude. We applied for the post and were delighted to be accepted. Our colleagues at work were very understanding and at short notice we were able to obtain 6 weeks leave to work at the post during October 2005.

The International Porter Protection Group (IPPG) was formed in 1997 and was the first organisation of its kind dedicated to addressing the problems of the mountain porter in Nepal. Its founder Dr Jim Duff, well known in the world of high altitude medicine not least for his Portable Altitude Chamber and his excellent Pocket and First Aid Wilderness Medicine Handbook, was prompted to found IPPG following the death of a porter while he was working at the Himalayan Rescue Association post at Manang on the Annapurna Circuit.  Over the last 8 years IPPG has worked to improve the lot of the mountain porter in a number of ways including the building of 2 porter shelters on the Annapurna Circuit; by education of trekkers, mountaineers and trekking companies and by close work with other organisations such as Community Action Nepal and Porters Progress.

Machermo is a village situated at an altitude of 4410m in the Gokyo Valley. The trek to Gokyo with its glacial lake system and the ascent of Gokyo Ri with its spectacular views over the Ngozumpa Glacier which takes in Cho Oyu, Everest, Makalu and countless other peaks of lesser height but equal beauty, are becoming increasingly popular as alternatives which avoid the ever more congested Khumbu Valley. Trekking to Gokyo and then crossing the Cho La to Dzonghla and onto Lobuche is also an increasingly popular way of  reaching Gorak Shep, Kala Pattar and Everest Base Camp. Unfortunately this growth in popularity has been accompanied by an increase in altitude illness to such an extent that the locals and helicopter rescue pilots have nicknamed it the valley 'Death Valley'. Because of the geography of the Gokyo Valley and the continuing ignorance of the dangers of altitude amongst both trekkers and porters there have been between 3 and 5 deaths a season in the valley.

The life of the mountain porter is hard. It is a myth that is widely held amongst Westerner visitors to Nepal that these men and women are immune to altitude illness and that they willingly carry loads in excess of their own body weight. Increasingly porters are middle hill Rai and Tamangs and are as susceptible to altitude illness as you are I. They carry their incredible loads, a feat which has been likened to serial weight lifting for hours at a time, because it is the only work they can get in one of the poorest countries in the world which is wracked by an effective civil war. They do this so that they and their families can survive. At night while western trekkers are asleep in their warm lodges or tents their porters often sleep out in caves or under boulders with only a fire and a tarpaulin to keep them warm. This lack of accommodation for porters is a major problem in the Khumbu region of Nepal and in the Gokyo Valley in particular. 

It was to address these twin problems of porter welfare and altitude illness in both porters and trekkers that IPPG set up a rescue post and porter shelter in Machermo, its most ambitious project to date. For the last 3 seasons the rescue post has been operating out of Namgyal Lodge in Machermo while a purpose built building has been constructed by Community Action Nepal (CAN). The new building will be operational from next season and will provide spacious facilities for the rescue post and its staff and a large dormitory area with kitchen facilities where porters will be able to sleep and cook in warmth and safety.

Our trip was preceded by the now familiar frenetic activity as we tried to balance our regular work with organising everything in time for our departure. Then suddenly we were back in Kathmandu. Something which Gerald Dubowitz said in 2003 and which I wrote in my journal at the time seemed so apt. “You have all these worries and anxieties before coming, and now that you are here your only thought is, ‘Why don’t we come back more often?’”  So many familiar sights, sounds and smells. The chaos at the airport; the closely huddled houses, half built, half derelict; the rows of tiny shops opening directly onto the street, with their weak lights casting a warm glow out into the growing dusk as our taxi fought its way through the usual traffic chaos. The few days we had in Kathmandu were taken up with a blur of organisation and welcome visits to friends who moved us with their warmth and hospitality. It was indeed good to be back.

And so to Lukla and an immensely enjoyable walk to Machermo along empty trails, staying in empty lodges. A marked contrast to the walk out at the height of the trekking season when the Khumbu seemed to have gone mad and was heaving with people. There is much to recommend visiting the Khumbu out of season even if the weather is not as reliable and the views less spectacular than with the coming of the clear days of autumn. One of the joys of the walk in was getting to know Chhewang the Sherpa manager of therescue post whose quiet efficiency, humour and kindness added so much to the success and enjoyment of our stay.

Very quickly our days at Machermo took on a regular routine. Up early to get out and take photographs in the spectacular dawn light. Breakfast was then usually followed by a steady trickle of  a mixture of trekkers, locals and porters seeking medical advice. Trekkers are charged western prices which they can claim back on their travel insurance and the money thus made enables the post to treat locals for a nominal fee and porters for free. Most trekkers were very willing to pay though the occasional personwho tried to avoid paying with the excuse that they did not have enough money was soon defeated when we produced the swipe machine for credit cards! It was impossible to know what would come through the door and the conditions seen ranged from the predictable acute mountain sickness, travellers’ diarrhoea, coughs, sore throats and colds to rip roaring lobar pneumonias; pyomyositis; parotitis and a young local boy with an infected accessory digit whose parents had tied hairs around it to amputate it. Duringour stay about half of the patients seen were westerners and half Nepalis. Any problems in locals that needed longer care were referred to the Hilary Trust Hospital at Khunde and trekkers crossing the Cho La who needed follow up were asked to call into the Himalayan Rescue Association at Pheriche with whom IPPG has an excellent relationship.

After lunch we would tour the lodges and camp sites in the village to advertise the presence of the rescue post and the afternoon talks on altitude illness. The talks proved exceedingly popular and during our time in Machermo several hundred people attended and heard how to avoid, recognise and treat altitude illness. Education is a central part of the work of the rescue post and is crucial to reducing the incidence of altitude related problems in the region. Once the new building is finished it is planned, with many of the porters in the village under one roof, to provide similar altitude education for the porters as well as education on other health issues such as cold injury; sexually transmitted diseases; alcohol abuse and also money management. While we were giving the talks Chhewang would be going around the local shelters making sure that the porters did not have any problems and making them aware of the rescue post. His excellent rapport with the porters, our visits to the lodges and people attending the talks were another source of patients and by the end of the afternoon another steady trickle of people were making their way to the treatment room door.

During our stay we treated a number of patients with severe high altitude pulmonary oedema who required helicopter evacuation. It was quite a challenge for somebody used to the endless supplies of piped oxygen on his university hospital intensive care unit to juggle the limited supplies of bottled oxygen and the short battery life of the oxygen concentrator with time in the Portable Altitude Chamber in patients whose oxygen saturation stubbornly refused to climb out of the mid-40 %s. Not all of the patients with severe altitude illness were trekkers and one porter in particular, Gopal, who was abandoned by his trekking group when he fell ill at Gokyo, stands out. Sadly Gopal’s story is not unique and when we flew out from Lukla we learnt from the Porters Progress office that in the same week a porter had died, presumably from altitude related illness, below the Mera La.

Gopal is 22 and fell ill at Gokyo after carrying a load from Namche to re-supply a Swiss group that had trekked to Gokyo via the less direct and more technical Renjo La. We do not know the details of how and why he was left to walk back down from Gokyo onhis own having passed the previous night struggling to breath. He was found semi-concious at the side of the trail by a group of independent British trekkers descending from Gokyo. Their Sherpa guide Furbar saved Gopal’s life by carrying him several kilometers to the IPPG Rescue Post on his back. When he got to us he was very sick with high altitude pulmonary oedema complicated by cerebral oedema and on a couple of occasions during the night we thought he might die as he refused to respond to treatment.

During the evening the trekkers who had found Gopal came to us and offered to pay for a helicopter evacuation for him in the morning. Normally this is impossible for porters as they do not have medical insurance and as yet IPPG does not have the funds to cover the $3500 it costs to organize a helicopter rescue. This was an incredibly generous gesture but we wondered, if they felt that way, if other people in the village might feel the same and be willing to share some of the cost of Gopal’s rescue. That night we went from lodge to lodge and tent to tent, explaining Gopal's situation and asking if anybody would be willing to contribute to the cost of a helicopter rescue. The response was overwhelming and we obtained pledges of $2800 with the four Britons agreeing to pick up the difference. As a result of peoples’ generosity Gopal was flown to Khunde Hospital the following morning and the decrease in altitude enabled him to recover rapidly. The day after his admission to Khunde he left hospital, tired but recovering, and was able to walk down to his home near Phakding.

Gopal’s case illustrates both the worst and the best of the treatment of porters by westerners. Each year sick porters are abandoned by their trekking or climbing groups. Very often the trekkers may not even be aware that one of their porters has fallen ill, let alone been abandoned to make their way back down the mountain alone. It will take a long time to change the way in which trekking companies operate in Nepal. There are some who already take the welfare of all of their staff very seriously but sadly these are in the minority. The best way to stop stories such as Gopal’s from happening is for climbers and trekkers to take an interest in their porters and to get to know these extraordinary men and women better and to insist that nobody who falls ill is allowed to descend without them being aware, and that they should always be accompanied down the mountain. For further advice on the ethical treatment of porters, see the IPPG website (www.ippg.net/guidelines/index.html). As Gopal’s story illustrates, individuals can make a difference and save lives.

Our stay at Machermo was over too quickly and it was with sadness but many wonderful memories that we left the village on a crisp autumn morning, our necks draped in prayer scarves. Chhewang accompanied us to the mani stones on the ridge above the village, the flapping prayer flags brilliant in the early morning light. He clasped our hands and smiled. “Come back soon,” he said. It would be impossible not to.

  
Machermo Rescue Post in Gokyo

 

 

Team = Emma, Chhewang our sherpa manager and Nick

 

Porter cave

Gopal who was later evacuated by helicopter

Fionn Bellis has been busy publishing her Medex 2003 Beau’s Lines data as well a case repot on a sick porter. I her spare time she has also been down to Antarctica and has sent in this snippet, “I finally managed to make to Antarctica! I went on behalf of the British Antartic Survey Medical Unit to retrieve a patient from Rothera in the middle of the Antarctic winter. All extremely exciting. They flew a Dash 7 down from Canada to meet me in the Falklands. The best bit was that the patient has made a largely spontaneous recovery by the time we got there so there wasn't the need for any scary heoic medical intevention! So got to go skiing on base as well! It really is more beautiful than I could ever have imagined. Just sad that the penguins were away for the winter!”

 

Stephan Sanders has also been busy publishing. Below is a plug for his new book as it appears in his promotional material.

Link to book details      

Stephan Sanders: Oxford Handbook for the Foundation Programme (2005)

Stephan has wanted to be a doctor since the age of 12, shortly after becoming disillusioned with the astronaut pension scheme. He trained at Nottingham medical school where he wrote a "Crash Course" textbook on the endocrine and reproductive systems during his paediatrics attachment. Surprisingly he still passed the paediatrics exam and decided this was clearly a good speciality. After medical school he worked in Queen's Medical Centre, Nottingham then Derbyshire Royal Infirmary, Derby. He eventually hopes to train as a clinical geneticist and will soon be starting a paediatrics rotation at Northwick Park, Harrow. Alongside genetics Stephan is also interested in high altitude and expedition medicine. He enjoys travelling, cycling, mountaineering and skiing in his spare time. In the future he hopes to unite the fields of quantum physics and ward based medicine to explain several medical phenomena including why you can never locate the notes and drug chart at the same time.

Denise Prior has again been raising money for Porter’s Progress. We mentioned in a previous Newsletter her event at the Royal Geographical Society and this was the outcome. “The Porters Progress evening on Thursday went tremendously well and we managed to net £2020!  This is going to the Child Porter programme of Porters Progress Nepal but it has yet to be decided precisely what aspect of that it will fund.  Thank you so much for sending out notices of the meetings to everyone - there were lots of Medex faces there - Mary Morrell was on the door ticket checking, Annabel brought a good party, Susan ran the Prize Draw and managed to weedle £202 out of people (she was very glamorously dressed!), Piotr, Ian Manoval and Lydia, David MacLean, Neil Richardson and Stephan Sanders - I'm certain there were more but I was running around a lot or stuck behind a table selling things”.

 

George and Maggie Wormald are busy teaching English as a foreign language in Nicaragua. They have sent in this. “We are having a great yet muddy, damp and wet time.  It’s the rainy season and the hurricanes are affecting the weather.  However from our house at 1275m we have no sickness - however dengue is rife lower down”.

 

Medex members Mary Selby a and Ian Wall have set up a schools trekking company. Full details are on their website, www.snowleopardschooltreks.co.uk , but this snippet gives a flavour of what they are up to. “We have just started a trekking company whose aim/focus is to take school parties trekking - in Nepal.

Sikkim, Ladakh, Tibet and Peru. We also offer Kilimanjaro to older kids, together with wilderness safaris in Botswana and Amazonian Ecuador. the new company got its ATOL this week and the website has just gone live although there are few things that will need to be ironed out this week. Any spreading of the word would be great - if any medex member knows of a school who might be interested in the adventure of a lifetime - we take them from age 6 upwards to 18+ then they should contact us on schooltreks@bigfoot.com or look at our website - www.snowleopardschooltreks.co.uk. Better still encourage the schools you know to look at the website and consider emailing us the name of the schools adventure pursuit/school trip contact.

These are major school trips but we encourage schools to consider extending the trip invitation to parents too. Most treks last between 2 and 3 weeks and all are accompanied by UK trek doc (usually me) and qualified IML (Ian).

We also focus on taking family groups and people with disabilities on trek, and our profits go to Community Action Nepal, a charity dedicated to improving the lives of the middle hill people of rural Nepal which was founded by, and is still run by Doug Scott. Ian and I are both Trustees of CAN so our hearts are very much with that organisation”.

 

Jonathan and Lynette Pote are off to NZ, probably permanently.    “I say probably, as my health has taken a turn for the worse, and NZ Immigration are still processing the Residency application - I may yet be deported back here, even if I don't steal a sheep.   Okay, so that was Australia, but close enough. We hope to establish a nice rural home south of Auckland, staying involved with aircraft, but adding sailing and smallholding to the equation.     Temporarily, we will be c/o S Grundy, 67 B Hadfield Street, Beach Haven, AUCKLAND, New Zealand, email as before.

 

It goes without saying that everyone is welcome if lucky enough to be in NZ”

 

Alex Truesdell is in the process of publishing too, "Training for Medical Support of Mountain Operations"...which also includes a lengthy discussion of the Medex International Mountain Medicine Diploma in the journal Military Medicine.

 

Bike mountaineering in China by George Wormald (before heading off to South America)

 

Maggie and I have just come back from 3 weeks cycle touring in China – I regret to say that the title is a misnomer as we went 960kms around Shanghai and the three neighbouring provinces, Shanghai Shi.  The highest point we climbed was 200m and except for a very large number of steep canal bridges it was mostly terrain.  In addition many hills around Hangzhou are quickly disappearing as they are mined and flattened to provide building materials.

 

However, it was relatively incident free.  The only accident was when I went into the back of Maggie after she had stopped to find the way. I was dreaming at the time.  We tried to book into the Party HQ in Wuxi (well there were a lot of big cars outside and a grand staircase entrance) but the historic pictures of Mao et al in the entrance hall gave it away.  A ferry we caught left us 20kms north of Shanghai so we negotiated going to the centre and The Bund in the morning rush hour.

 

We took our own bikes (made in Taiwan and Vietnam) but they have a larger frame than the average Chinese bikes which didn’t have gears and only rod brakes. We stayed in private houses, hotels and one brothel come hotel.  Lots of these around and very inexpensive - £5 for 2 in a private house to £30 for 2 in 5 star luxury.  The latter has the benefit of a white gloved flunky to take the dusty panniers up to the room. Street maps were available in bookshops in the major towns and cities and these had a rough approximation of the road system in the province.  However the number of new roads has to be seen to be believed.  Many end no-where but the infrastructure is being laid down for the future and the speed of construction is probably 5 times that we are used to.

 

Everyone was welcoming although in many areas we were the first Westerners to be seen and a few families are now telling stories of the big nosed Martians in helmets that had landed.  Travelling by bike is by the Chinese is to go to work or school and we only saw 3 cyclist for sport/pleasure out of the millions.   However generally you can pass unnoticed transparently through towns and villages (oh and the dozens of industrial estates) and watch traditional life juxtapositioned against frantic progress.

 

                                

 

  

 

 

Jim Milledge gave the tribute to Mike Ward at Mike’s funeral. Mike participated in several of the early Plas y Brenin Courses and, of course, was a towering figure in Mountain Medicine. It seems appropriate to publish Jim’s tribute in full.

Michael P. Ward CBE. FRCS

Funeral tribute, Oct 31st 2005

 

We are here today to celebrate the life of our friend and companion, Michael Ward.

 

When Jane asked me to give this appreciation of Mike, I felt honoured to be asked but somewhat inadequate for the task; even more so as the obituaries came out in four broad-sheet newspapers. But Pat, my wife, said I was not here to give another obituary far less a biography, but to recall to you the man as I remember him, his strengths and foibles.

 

I first got to know Mike in 1960 when I was working with Griffith Pugh preparing for the Silver Hut Expedition. I was somewhat in awe of Mike, five years my senior and already famous as an Everester. I did not realise then how important a part he had played in discovering the route up Everest from the Nepal side. This has been well told in the obituaries so I will not repeat the story of his work in 1949 in the RGS archives etc. Except to say that, having recently trekked the route they followed 1951 to reach Solu Khumbu from the South, I am even more impressed by their exploratory prowess at a time when the country was far less mapped and equipped with much fewer bridges than now. They had a tough time with monsoon rain, leaches, route finding in jungle, hazardous river crossing and attack by hornets. A famous picture from this trip is of Mike, Shipton and Murray apparently up to their necks in the river Arun with umbrellas up. I remember seeing this picture in a climbing magazine caption competition. The winning entry ran, “Are you sure, Caruthers, that the blue lines on the map are footpaths?”

 

Mike was Griff’s first choice for his team for the Silver Hut Expedition. They had met when Mike was preparing for the 1951 reconnaissance Expedition. I quote from an article Mike wrote recently.

 

“The first meeting was characteristic. Griff was sitting in a free-standing Victorian bath in water with ice cubes floating on the surface in the middle of a self-imposed hypothermia experiment. He had forgotten our meeting. At the next encounter he looked at the photographs of the proposed route on Everest and said that he could ski down it and if he could do that, we could climb up it. The mountaineering difficulties were thus disposed of and we turned to the scientific problems.” These were the provision of a satifactory oxygen system and the importance of adequate fluid intake for climbers high on Everest, factors which Mike later believed had been crucial to the success of the ’53 expedition. Griff gathered important data on these topics in 1952 on Cho Oyu but it is interesting that he and Mike had discussed these matters even before the ‘51 trip.

 

It is clear they hit it off well together. They both considered themselves apart from the establishment of both medicine and mountaineering. They had little time for the niceties of social conventions or small talk. Mike admired Pugh and was a great champion of his contribution to the success of Everest 1953. There is no doubt that through his writing and lecturing he helped establish Pugh’s reputation.

 

The ’51 expedition must have been fantastic for Mike, not only to find the route up the Khumbu glacier and ice-fall and to find his research vindicated, but then to go exploring with Eric Shipton into the unknown area west of Everest, find those famous Yeti footprints and escape from the Chinese boarder guards. This love of exploration stayed with Mike throughout his life. In 1964 he was able, with Fred Jackson, a cardiologist, to get into Bhutan and explore remote regions north and east towards the boarder with Tibet. In 1980 he got permission to reconnoitre Mount Kongur in Xinjiang China with Chris Bonington and Al Rouse before leading a successful expedition to climb it the following year. In 1985-6 he was on the Royal Society’s expedition which made a South-North traverse of Tibet. His interest in maps and the history of exploration of the Himalaya was also life long. Starting from his unearthing of the Milne-Hinks map in 1949 to the publication of his scholarly book, “Everest: a thousand years of exploration” in 2003. Between these dates he wrote numerous geographical, historical papers including some in the Alpine Journal on the Pundits who worked for the survey of India in the late nineteenth and early twentieth centuries. In fact he had been asked to author a further book on these Pundits whose work is still not widely recognised. He had completed about two thirds of this book when he died. Before that he had been closely collaborating with Tony Astle who has been writing a book on the 1935 Everest Expedition. Tony was telling me how he admired Mike’s continuing wonderful enthusiasm for exploration both on the ground and in archives, especially of the RGS, of which he had an encyclopaedic knowledge.

 

I will not dwell on the 1953 Everest Expedition in which Mike was the medical officer. We have members of that trip with us today and they are much better placed than I am to tell you about that. However, I cannot resist telling you a story I got from Mike Westmacott about Ward’s health talk to the team before setting out for Nepal. He impressed upon them the importance of visiting their dentist well in advance of the expedition and getting any required dental work done. “Because,” he said, “I can pull teeth. - But I’m not very good at it!”

 

The Silver Hut Expedition, 1960-61 was a wonderful unique experience. Led by Sir Edmund Hillary with Pugh as the scientific leader, its aims were to study the long term effect of really high altitude on human physiology of acclimatization. We were nine months out of Kathmandu, most of the time at altitude in the Everest region. The winter was spent in the Silver Hut at 5800m (19,000ft). We were a very mixed team of climbers and scientists drawn about equally from New Zealand, USA and UK. Mike trekked out in December with John West each successfully carrying a Lloyd-Haldane apparatus, a delicate thing of blown glass for measuring oxygen and carbon dioxide in gas. These were crucial to many of our projects and the original ones we had brought had both been broken. Mike was official medical officer to the 22 strong team, many of whom were also medics. He was senior to most of us in both years and certainly in mountaineering experience. I think to the New Zealanders and Americans, playing the part of “rough Colonials”, his background (Public School and Cambridge) and his accent suggested that he belonged to the aristocracy. Mike played up to this role and I remember him addressing them as, “My dear chap”, much to their amusement.

 

By late February the Silver Hut was getting crowded and so Griff was quite happy to agree that Mike, Barry Bishop, Wally Romanes and Mike Gill go off and attempt Ama Dablam. The ascent of this most beautiful of mountains was probably the highlight of Mike’s mountaineering. The boldness of this unassisted, technical climb was years ahead of its time. It was unrepeated for about 20 years.

 

In the Spring we moved over the Barun Plateau to attempt Makalu and conducted experiments at advanced base camp (6300m, 21000ft) and even a couple of measurements of VO2 max using the stationary bike were carried out by Mike and John West on Makalu Col (7400m) still, 45 years on, the record for the highest altitude at which this has been measured. I could go on for ages about this expedition, which for me turned out to be as much a life-changing experience as the ’53 trip was for those on it.

 

After the Silver Hut, Betty and I spent 10 years in India but kept in touch with Mike. He tried, in the ‘60s, unsuccessfully to get permission for an expedition to Shisi Pangma the last unclimbed 8000m peak. After our return to UK in 1972 Mike and I planned a number of trips which failed to come off but then started a series of studies in this country and later Switzerland, on the effect of hill walking exercise on fluid and electrolyte balance in ourselves. These were field studies with full metabolic control on a fixed diet, the exercise being hill walking for 8 hours a day for 5 consecutive days bracketed by 4 control days. We collected a group of enthusiasts including a Professor of Nuclear Medicine, an Orthopaedic Surgeon, a Naval Surgeon, a Gynaecologist, a Medical Technician as well as us two. We called ourselves “The Worshipful Company of Gentlemen Physiologists” but to keep us on the straight and narrow we included one card carrying professional physiologist. Over the years we had four two week studies in North Wales, the Lakes and Switzerland and made some quite important findings in this area which we hoped might have a bearing on high altitude pulmonary edema.

 

In 1975 Mike published the first textbook on Mountain Medicine in the world. The book was probably ahead of its time in that there were still very few people interested in the subject. In 1984, when we were on a small scientific expedition to Pikes Peak in Colorado, I asked Mike if he was thinking of a second edition of “Mountain Medicine”. He had not considered it but did so soon after and asked me to join him in the project. At the publisher’s suggestion we asked John West to join and so was born, “High Altitude Medicine & Physiology” by Ward, Milledge and West, now the standard textbook on the subject. The 3rd edition was published in 2000. Mike was not a technophile. He not only eschewed the computer, he hadn’t even got into the typewriter age! The result was that for all his chapters, he wrote the draft in his doctors hand writing, I reduced this to a computer Word file, posted the print-out to him for correction. On its return I would e-mail a final draft to John West in California. In this way all his papers and articles were produced! He was fortunate to have Johanna Merz, editor of the Alpine Journal, to do this job for him for many articles and for his Everest exploration book, including making the index.

 

I cannot speak about his long career as a surgeon in St Andrew’s Hospital Bow and later at The Homerton Hospital also in the East End. I know he was highly regarded as a teacher and an all round surgeon ready to undertake the management of injuries to head, chest, abdomen or limbs as well as the usual round of elective surgery. He was asked to stay on and work after the statuary retirement age of 65 for another three years and they then had to appoint two surgeons to take his place. He never took on private practice, believing that the NHS should provide a sufficiently good service that private practice was not necessary (would it were so). 

 

In the latter part of his surgical career he began to take a more active part in the Worshipful Society of Apothecaries and after retirement became Master of the Society. In this, he not only attended the very numerous social functions required of the role but took an active part in developing courses and examinations in areas such as the management of disasters. I remember attending a very posh Dinner and Ball as his guest at the Society’s lovely old buildings in the city and he certainly seemed to be enjoying this very social occasion.

 

He was justifiably proud of the house in Lurgashall which he and Jane largely designed and built and loved the garden and grounds. He was very proud too of their son Mark’s achievements, gaining a scholarship to Eton, an organ scholarship to Oxford and 9 years ago presenting him and Jane with a granddaughter. His last few years were dogged by ill health, first serious kidney trouble then that horrendous car accident and operations following it. Jane nursed him back from each critical situation. It is ironic that just when he seemed to be gaining health again he should be struck down by sudden death. For Mike, of course he has been spared a lingering death but our hearts go out to those left to mourn.

 

Mike was, in many ways, a very private man – a typical English Gentleman. But he clearly was a deeper and more complicated person than appeared on the surface. He had a deep abiding love of mountains and landscape and would have subscribed to much of Geoffrey Winthrop Young’s philosophy I think. He chose a quote from Young as the title of his autobiography, “In This Short Span” taken from Young’s most famous poem “The Cragsman”. In his anthology, “A Mountaineer’s Companion” Mike included five pieces by him. One was a poem I had not come across before which could stand as a sort of epitaph for Mike. It was written by him as a comparatively young man after he lost his leg in the First World War. But for Mike and we of Mike’s generation, it speaks to us, as we have to adjust to reducing physical performance and when memories of halcyon days, we have shared in the mountains, become more important. The first and last verses go:-

 

I have not lost the magic of long days;

I live them, dream them still.

Still I am master of the starry ways,

And freeman of the hill.

Shattered my glass, ere half the sands had run –

I hold the heights, I hold the heights I won.

 

What if I live no more those kingly days?

Their night sleeps with me still.

I dream my feet upon the starry ways;

My heart rests in the hill.

I may not grudge the little left undone;

I hold the heights, I keep the dreams I won.

 

                                       Geoffrey Winthrop Young

 

But, as I said at the start, we are here to celebrate a life and in Michael Ward’s case we can truly say, “A life fulfilled”. I personally feel a great debt of gratitude to Mike and will miss him. He would probably say, “Come, come, my dear chap”. – He was indeed, A Very Dear Chap.

 

Jim Milledge, Rickmansworth, October 2005    

Mountain Medicine Diploma

The Diploma moves from strength to strength with a new cohort of future diplomats starting off this Autumn. The Scottish Winter Skills course is being run at Glencoe between 26/2/06-4/3/06 and Alpine Mountaineering Skills Course at Arolla between 3/9/06-9/9/06. The theory courses are being run in 2006 as follows: STC Sat 20th May until Thurs 25th May and PYB Sat 2nd Dec until Thurs 7th Dec.

 

MEDEX GOING OFF LINE

 

As indicated earlier we are going to out of email range from 1st January – 22nd February 2006