Medex Newsletter, number 13

May 2003

As many will know the Medex 2003 Expedition to Nepal is now over and most members are  back in the UK. This was our third Expedition to Nepal and went very well indeed though we did not succeed in our ambition to climb Ombigaichen – more on this later.

 Expedition Report: It is important to produce a good quality report as it provides something tangible for employers, sponsors, spouses and, of course, a valuable keepsake. In the past we have run both literature and photographic competitions in order to solicit as many contributions as possible. We plan to do this once again and the timetable and requirements are as follows:

1. Written articles to be emailed to be by 5/7/03, they will be judged and a £50 and £25 (1st and 2nd) prizes awarded at Hyssington July 12th. You can submit as many written articles as you wish but none should be more than 500 words. They can be about any aspect of the trip. Please see the 98 and the 94 Reports on the web for inspiration. All articles will be included in the Report

2. Photos emailed to me by same deadline but please bring originals to Hyssington if you don’t have them on disc. All emailed pictures will be projected at Hyssington and those together with the originals will be judged Saturday night. Again, there Is a £50 and a £25 prize.

We would particularly welcome contributions from those members who took responsibility for specific areas of the expedition for instance from medical officers, research project leaders, power generators, environmental officers etc etc. Brief factual accounts please with hints and suggestions for the future.

Our previous expedition reports were published in paper and subsequently on the web. This time we hope to produce a proper web based report and will pint off some limited edition paper editions. I’ve just bought some web publishing software to make it all happen. All I have to do now is figure out how to use it!

Below is a brief summary of the Expedition.

Summary of Medex 2003

After what seemed like years of political uncertainty we finally took the decision to go to Nepal late last year. Maoists had been causing turmoil in Nepal for 6 years and in the autumn of 2002 there seemed to be no sign of abatement. Coupled with that as 2002 drew to a close it seemed increasingly likely that the second Gulf War would be nicely timed to coincide with our Expedition. With so much uncertainty we abandoned our previous practice booking the international flights centrally and, instead asked individuals to make their own arrangements. We also drew up a voluntary bond system in order to arrange timely evacuation should the domestic Nepalese politics erupt whilst we were there.

 The scientific component of the Expedition began in London in January 2003 with the data collection weekends. These were very well attended and ran extremely well. Many members took the time and trouble to journey in from their various corners of the world and were rewarded by seeing, for the first time, what the final shape of the Expedition would  be. The base line data was collected with a minimum of fuss and the efficiency of our scientific team augured well for what would lie ahead at Base Camp.

 At the end of January we were heartened to hear the unexpected news of a ceasefire in Kathmandu. I, for one, breathed a sigh of relief at this news though there was much speculation as to whether it would hold. Less welcome news was that the second Gulf War seemed to have been timetabled to start on the day that many members were due to fly out. Many had chosen the cheaper Gulf Air flights and transited through Abu Dhabi. As it transpired, however, only a few members had their flights cancelled as airlines scrambled to consolidate their bookings. All arrived safely, without incident and more or less on time in Kathmandu during late March.

 The 57 members that took part were formed into 5 teams of between 10 and 13 each. Some of these groups were self selected others were put together by Medex organisers. Group 4 was the first team to head for Nepal and was responsible for much of the logistical work in both Kathmandu and Base camp. Their brief was to trek in first and set up the science projects at Base Camp in time for the arrival of the later teams. We were very fortunate in that George Wormald, who had worked tirelessly in the UK to freight the 1000kg of research equipment, was able to fly out to Kathmandu in mid March to oversee the Nepali end of the freight handling.

 Groups 1 and 3 were to leave Kathmandu 4 days after group 4.  Medex 2  left the next day and group 5  six days after group 2. We hoped that this staggering of departures would mean that the arrival of un-acclimatised subjects at Base Camp would be spread over seven or eight days and thus ensure that Base Camp data collection would be manageable. This seemed to work out OK although some anxiety was expressed when group 1 was, at one stage, only 1 day behind the advance party. The command, “Go back to Goa and stay there for 2 months!” was said to have echoed across the Mera La!

 All members trekked in using the same route except Rajiv Joshi and John Milledge who took a short cut and flew to Lukla as they had limited time. For the rest of us we took the Twin Otter flight from Kathmandu to Tumlingtar in the Arun Valley and began trekking the next day from there. The airstrip is at just 400 metres and it is disconcerting, when bound for lofty Himalayan Peaks, to spend the first hour on trek going down. We  bottomed out at 300 metres before crossing the Arun River and heading off up a tributary. Nepal is sub tropical and, at 300 metres it is very hot and humid. Accordingly we spent much of the early part of the trek drenched in either sweat or soaked by rain and hail. My drug company golf umbrella provided excellent shade and shelter.

 Although the trail from Tumlingtar Base Camp is only 40 miles there is a stunning amount of up and down as it crosses valley after valley. We were to emerge at Base Camp considerably fitter having climbed 40,000 feet through steamy bamboo jungle and icy, glaciated passes. We were all much comforted when Jim Milledge conceded that it was, indeed, a “strenuous trek”. Despite the difficulties all but one member succeeded in the crossing the 5,400 metre pass that led down into the Hongu Valley and our Base Camp. Unfortunately one member had to retreat before the pass having become debilitated by a lengthy bout of diarrhoea. He was able to take the short exit to the airstrip at Lukla.

The first 14 days of the trek traversed the remote Nepalese foothills passing through many villages, valleys and passes to 3,400 metres. We came across no other trekkers during this time. Many of the villages displayed red flags and slogans pledging allegiance  to the Maoist cause. All groups except Medex 2 had some kind of direct Maoist encounter. Groups 1 and 3 were stopped in the village of Bung and a polite request was made that they join the Maoists. They were initially asked for Rs30,000 but managed to negotiate a discount for expatriate membership. I think they ended paying around Rs250 each (about £2) except, of course, for Stephan who, in true student fashion, managed to evade a call for cash by running off. He was, I understand, hotly pursued by men with a curious array of firearms which included shotguns and flintlocks.

 Group 5 faced down another request for Rs30,000 by using Jim’s finely honed negotiating skills. A former Medical Director of Northwick Park Hospital is used to negotiating with politicians and doctors and a Maoist armed with a hand grenade proved a poor match! I won’t spoil Jim’s story as I am sure it will appear in the full Report.

 Later in the Expedition Group 3 had a second Maoist encounter but this ended on excellent terms when they were, en mass, able to produce their membership cards and swap comradely comments about George W and his antics in the Gulf.

 Contrary to our fears the Maoist proved to be an entertaining diversion from the ups and downs of the approach trek. I am very pleased to say that all of the voluntary bonds have now been refunded.

 Late snows blocked the planned high route via Panch Pokari and so we had to descend all the way back down to the Hinku River and then climb very steeply back up before following a new, and very strenuous trail along the western side of the Hinku Valley. Flowering rhododendron, magnolia and a campsite cut out of a bamboo jungle punctuated the impossibly steep ascents and descents before popping out into the excoriated valley floor at Kote.

 The village at Kote had, 6 years earlier, been destroyed.  A natural dam burst that sent a torrent of mud, water and rock surging down the valley. New bamboo huts have sprung up in the valley that has been freshly gouged by this terrifying force of nature.

 All groups rested at Tagnac underneath jagged slopes of Kangtega and Kusum Kungru. At 4,200metres we were glad to take time to acclimatise especially as we had finally arrived amongst the mighty  Himalayas. The foot hills were now all well behind us and were swathed in the obligatory afternoon mists. Ahead was the Mera La which, at 5,400 metres provides a formidable barrier to trekkers and porters alike as we were to find out.

 At Tagnac we first met a Japanese commercial expedition bound for the Mera La. They had arrived at 4,000 meters 4 days after leaving Kathmandu and planned to take no time to acclimatise before their attempt to climb Mera – a 6,400 metre mountain south of the Mera La. The plan seemed foolish. More so when I met one of their members. I chatted with this elderly and oedematous lady and it was clear she was already struggling. We were to pass her the next day as she made pain staking progress towards their next camp at Khari. She did arrive there some hours after us but sadly she never left. Four days later, whilst her companions stood on the summit of Mera, she died. A needless and avoidable death about which there will be more in the full Report.

 Khari at 5,000 metres proved the site of 2 further mishaps during our Expedition. Fortunately neither proved fatal but they both came very close. A lowland porter employed by a Russian expedition developed severe high altitude pulmonary oedema in the night and was resuscitated by group 2 with Certec bag, oxygen and nifedipine. By the morning he had improved very significantly and was able to descend escorted by one of our medical officers. Later on in the expedition one of our porters, whilst ascending from the Hongu Valley to the Meral La collapsed. He was carried over the pass and down to Khari and arrived in a very poor state. Several of our doctors worked on him and diagnosed a severe pneumonia which they were able to treat with sophisticated western drugs. However, it was Tracey, our specialist respiratory physiotherapist from the Brompton, who worked the magic and brought his saturations up from 40% to 80%. By chance, she was able to refer him on to another chest physiotherapist in Tagnac the next day.

 The glaciated Mera La was magnificent and most of us had superb views. All groups, apart from Medex 2, then descended to the Hongu Valley before following the valley up to our Base Camp to the north of Chamlang. Group 2, anxious to delay its arrival at base camp, made an attempt on Mera Peak. High camp was established at 5,800 metres in one day and then occupied the next day. A violent thunder storm broke in the afternoon and evening before our attempt and a few inches of snow were deposited. By 4 am the storm had passed and 6 people set off for the summit which they reached by 10am without event. Sally had been suffering from a respiratory infection and this, combined with a dose of acute mountain sickness thwarted our attempt but, never the less, we enjoyed the fantastic views from High Camp of Kangchenjunga, Makalu, Lhotse and Everest.

 Base Camp was on a flat meadow near the upper Hongu River now little more than a stream. Surrounded by spectacular peaks it was denied a view of Everest by a twist in the valley. Chamlang, 7,100 metres, dominates the valley and Base Camp. When Group 4 had arrived they had to dig deeply into the snow in order to pitch the tents. Three helicopter loads of research kit were flown in from Kathmandu via Lukla. All had gone without a hitch and, by the time group 2 arrived Base Camp was a serene and orderly place. It felt a bit like the grid of an American town with everything laid out, toilet tents as well, in a planned and logical way. Not at all the medieval growth of our previous Base Camps! Undoubtedly Jim Duffy, our base camp manager on this expedition has a tidy mind!

 Thanks to the efforts of Jim, Denzil and Gerald the place not only looked tidy but it was also functioning like  a well oiled machine. No noisy petrol generator – the freighting company had refused to take it blaming, for some reason, the war in the Gulf! Instead electricity was efficiently and almost silently generated by wind and sun.  The scientists were all quietly going about their business of data collection and most of their subjects were compliant and, even more surprisingly, uncomplaining. Drips and arterial lines were inserted, curious cannulae were being poked into all kinds of orifices and the usual bunch were pedalling the one wheeled cycle – now on its third Medex outing to the Himalaya. The whole scene was one of calm and orderly scientific endeavour. The only odd thing is that we were 5,000 metres up in the Himalaya and when the afternoon clouds rolled in the temperature plummeted like a stone bottoming out at -10 or so just before dawn.

 The huge dome tent proved the social focus in the evenings and one night we counted 65 in there before the dancing began. Clapping to the ceaseless tune of Risamfiriri inside the big dome with the condensation dripping like rain as all 65 danced with those curious, squirming, sherpa hand movements. Smiling faces, burnt by the sun and unshaven for weeks. These are  my happiest memories of Base Camp.

 As the projects came to their end the groups began to drift away. Most headed back down the Hongu bound for Mera Peak. All but 1 in Group 1 summited and all but 2 of group 5. Group 3 made an attempt but were thwarted by a storm as too, earlier in the Expedition, were group 4. After Mera Groups 1,3 and 5 were able to exit via the Zwatra La to Lukla in four or five days.

 We in Group 2 chose to be different and press ganged a Michelle, Stephan, Matt, Piotr and Mireille to join us. We went up the Hongu to its source passing the moraine lakes of Panch Pokari as we went. We turned left and climbed up the moraines of the Hongu glacier and camped in a blizzard at 5,600 metres below the infamous Amphu Lapcha. It was on this pass 5 years earlier that 9 people on an Australian expedition had died in an avalanche.

 We spent a bitterly cold night in camp and set off early for the pass. Fortunately our Sherpa staff knew exactly where they were going for the route was far from obvious. We climbed up under a steeply seraced glacier and then, in a rising, rocky traverse entered a loose gulley which we ascended on fixed ropes. This led out onto a rocky slope which we climbed for the final few metres to a precipitous rock ridge. There we waited for 3 hours as porters and their loads were lowered on separate ropes. It seemed  take an age to get everyone over. Fourteen members, 22 porters, 8 kitchen staff, 2 local sherpa guides, 1 climbing sherpa and 1 sirdar. Some 48 souls in all had to traverse under steep rock, abseil down a gentle snow ramp then queue for the “big” abseil over a rocky bluff and then down an icy gully. From there we traversed 45 degree snow slopes on north facing, unconsolidated snow. Thankfully the pack was stable and there was minimal risk of avalanche during our descent. The porters tobogganed on their loads down the final 300 metre snow ramp. We went on our backsides! However we arrived it was great to get into camp just before dark that night as all had had a long day. Much of our gear was retrieved by torch light that night as many of the loads - left the previous afternoon by porters lowered long before their loads – were thrown down the mountain!

 Interestingly breakfast, the next morning was delayed, as some poor soul had to climb back up to the pass to retrieve the milk powder!

 The walk from Amphu Camp down to Chukung was, for me, one of the best on the trip. The whole south face of Lhotse was before us and we had survived the Amphu Lapcha. Stephan and Matt broke off to attempt one of the other mountains in the Chukung Valley and I am pleased to say they succeeded in good style. For Sally and I we were now in familiar territory and spent the  next few days retracing our steps of ’94 down the Khumbu. But Oh how it has changed. Smoky huts daubed with yak dung have grown into substantial, stone built lodges with all – well nearly!- the comforts of a hotel. Shacks have grown into prosperous lodges and everywhere there is building and enterprise. The Khumbu has become a money making machine. No more so than in Namche Bazaar which now hosts dance bars and internet cafes.

 Those that hadn’t sampled the delights of the Khumbu before scampered off to visit Kala Pattar and glimpse the magnificent splendour of Everest. Still a majestic sight even with a sprawling base camp at her foot accommodating 35 expeditions.

 Whilst all this was going on Group 4 packed up Base Camp and despatched the research gear by helicopter to Kathmandu. Once again all executed with military precision. Job completed they, with a few well chosen sherpas, set off to cross the other pass between Hongu and Khumbu  - the Mingbo La. This they did in 2 very long days that involved several abseils both on the pass itself and on the Mingbo Glacier below. On the way they were able to inspect our other mountaineering objective Ombigaichen. This had first been climbed by Jim Milledge in the winter of 1960 and it had been our intention to climb it again. It seems however that it will remain a winter only mountain as the snow slopes that Jim had climbed were, in spring at least, denuded of snow and now consisted of hideously loose rock.

 On the 28th April all groups, somewhat trek weary it has to be said, assembled in Lukla for a night of celebration before flying out to Kathmandu. Chang, sherpa dancing and more smiling, happy faces.

 Back in Kathmandu the men lost 10 years as their beards came off and everyone counted the cost of the previous 5 weeks in lost weight. I think the record goes to Michael who shed 11kg though more on this in the Report. Attempts to regain the lost lard were largely thwarted by restaurants like Rum Doodle who manage to dish the dirt with the dinner and left many staring into the porcelain the following night. Fine food was however served up at the party given by our trekking agent who treated everyone to a fine Tibetan meal. Medex followed this up with dinner for 95 on the roof of the Marshygandi Hotel with entertainment by a team of “cultural dancers and musicians”. Hmmm!

 With Mera and the Amphu Lapcha in the bag the last remaining danger was a new threat to the world. A new disease, SARS, had taken a grip on the far east and paranoia was running high. We boarded our flight to Bangkok and a few minutes later I had one of the paroxysms of coughing I had grown used to over the last few weeks. Instantly I was pounced on by the air hostess who gave both me and my neighbour a mask.

 We have been back a week now and the tan is fading but sadly not the cough. I suspect the weight is creeping back on too but so too is the feeling of emptiness now the big project is done and dusted. It seems strange not to be spending my evenings answering emails and chatting to amazingly enthusiastic people on the phone about how they might climb their first Himalayan mountain. The thought inevitably then is what’s next Definitely Antarctica and maybe back to Western Nepal (Dhulagiri, Mustang and Dolpo). More of which anon!

 Mountain Medicine Diploma:  As well as all the feverish expedition activity the Diploma has also taken a huge leap forward. David Hillebrandt, despite a catastrophic computer meltdown, has nurtured a lengthy email debate and organised the first practical training course. This took place in Scotland in early February and much innovation has grown out of it despite the predictably inclement weather. The diploma is on course to have both university and UIAA accreditation. This “pilot” course has been undertaken by a, now well established, faculty. Those that are interested in joining the first intake should contact Peter Barry

Forthcoming dates

July 12th – 13th, Hyssington BBQ

Once again we are inviting everyone to our annual Mid Wales BBQ and we hope to make this the main post expedition meet with slide shows, reunions and plenty of food and drink. All are welcome not just expedition members. Though camping is free we do, on this occasion, hope to be able to raise some money for the restoration of Hyssington Church so please bring your wallets! On the agenda will be where next and when. PLEASE LET US KNOW IF YOU CAN MAKE IT SO THAT WE CAN CO-ORDINATE THE FOOD. PLEASE BRING SOMETHING TO DRINK, SOME SALAD AND/OR A  DESSERT. WE WILL SUPPLY THE BBQ FODDER.

October 4th - 5th 2003, 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 £28 will secure your place for dinner, made payable to Medex and sent to the Pinfold, Hyssington, Montgomery, Powys.

Plas y Brenin 2003. Mountain and High Altitude Medicine and Physiology course 21-23rd November 2003. This course is once again organised by Peter Barry and has now become a highly popular and successful event. This course will also form part of the academic component of the Diploma Course.

Expedition Doctor for Lesotho this summer.

Nick Thompson Email wrote: “I'm looking for an expedition doctor and wonder if you know someone who might fill the bill as my current medic has had to pull out owing to father's terminal illness. There is another doc on the team but he is JHO and does not feel confident enough to take on the full role. there is a good casevac and repatriation plan Nearest/best hospital Bloemfontein.  Doc would ideally be 25 to 40 and with experience/liking for being with young people. Whilst not attached to a group he /she would get out with the groups as much as possible”.

 Simon and Sally