Medex Newsletter, 14

September 2003

Please remember to book your meal direct with Medex for the Old Dungeon Ghyll Hotel in October. We must know numbers to arrange catering. Booking is made by sending a cheque, payable to Medex, for £28. As usual please make your own accommodation arrangements. Full details are posted later in this Newsletter.

For those that were on our 2003 Expedition PLEASE remember we need your reports, stories, accounts, observations for the Expedition Report. If you don't know what to write visit our website where the draft report is published. Look too at our other expedition reports. PLEASE send me your contributions as soon as possible so that we can finish the Report.

Hyssington BBQ

Two Medex meetings have taken place during the summer. The annual Hyssington BBQ was blessed, once again, by fantastic weather allowing a full compliment of activities. Mountain biking, rock and grass climbing on Arenig Fawr, serious socialising and parapenting. The BBQ was very well attended and we even encountered food shortages! The Diploma Team met on the Saturday afternoon and were able to put in place the final touches to the new Diploma in Mountain Medicine. Information on this appears later in this Newsletter.

An excellent meeting was held in the Village Hall on Sunday morning and it was great, once again, to sense the enthusiasm that lies at the heart of Medex. We floated two possible future Expeditions and there appeared to be universal support for these. Accordingly I have worked up a couple of proposals for 2006 and 2007 and these appear later in this Newsletter. We also discussed the future of Medex subscriptions and agreed that  British Mountaineering Council (BMC) associate membership was no longer an attractive or worthwhile feature of Medex Membership. This is mainly due to the fact that a lot of our members live overseas and can derive no benefit from the BMC though we are still bound by the BMC rules to pay their levy. Instead we offered to propose and second individual Medex members to join the Alpine Club where they will enjoy both reciprocal rights and associate membership of the BMC. 

We also agreed that Medex Membership should last for a number of years rather than being annually renewable as this saves considerable administrative effort. We have subsequently decided that the new period of membership should be for 4 years which will take us up to the end of the 2007 West Nepal Expedition. The cost of this four year membership will be £45 and of this a £10 levy will go direct to the charitable work of Medical Expeditions. The remainder will be used to cover administrative cost associated with maintaining the website and email services. As from 2004 Newsletters will all be disseminated by email and will only be mailed by post if specifically requested. There will be £10 surcharge for postal versions.

Jill Sutcliffe mooted the idea of compiling an illustrated book of our various adventures and research findings. We hope to work towards this over the next 4 or 5 years.

We also decided to organise a Ski trip to Chamonix in March 2004 and details of this too appear later in this Newsletter.


In August Paul Richards organised a very well attended climbing weekend at the Roaches and we were pleased to welcome some new faces. Thanks Paul for the great organisation.


The website is in the process of being completely re-written and will be demonstrated at the Old Dungeon Ghyll Meet in October. It includes hundreds of photos. A draft version be seen on our website at present. If there is anything that you would like to contribute to it please send it in to me by email.

Expedition Opportunities

Piotr Szawarski is looking for Medex members to join him in Mexico. Pico De Orizaba, 5611m in Mexico,
November 2004. Full details are posted in the "Members Private Trips" section of our website.
Please Contact Piotr Szawarsk,i if interested.

Ben Boddy, is seeking an expedition medic and has sent in this note:
We are planning an expedition in 2005 going to Peru in mid July to late August (4-6 weeks). We will be taking approx. 60 young people between the ages of 16-20. BSES is a not profit making charity based at the RGS. All of our expeditions have scientific field work projects that often support host country organisations and typically cover surveying, glaciology, ornithology, physiology and many other topics. The recce is heading out in mid August this year to establish the actual base camp. At present it is proposed to have the base camp at 3000m and so we are trying to find some good expedition doctors with experience + knowledge of altitude medicine. All expedition members have to make a financial contribution and it is expected that this will be approx £1000 including everything from flights and food to insurance. If you know of anyone who would be interested please send them these details and ask them to drop me an email or call on 0207 5913141.


People News

Ollie Kemp and Neil Richardson both got firsts for their BSc projects on GTN headache at altitude, and 2:1 s for their BSc's overall. Congratulations!

John Milledge has been busy since his return from Nepal. Whilst most of us were acclimatising to clean sheets and soft beds John headed for Ireland with his Kayak. Alone, with his tent and kayak, he paddled all the way around Ireland. Jim kept us updated with a regular emailed report as John progressed around the coast. On route he encountered floating bodies, Irish hospitality, a good deal of weather and a near miss with the HSS ferry in Dublin Bay. The ferry was travelling at 40 knots! John is resting for a few weeks now before he flies out to Malawi to work for the next 2 years.

Martin Pengilly will be running in the Everest marathon in November.

Gwen Richards is a GP on sabbatical February to May 2004 and is looking for excuse to visit Nepal again, e.g. as a trek doctor, or other voluntary non medical work. Experience in altitude medicine - Himalayan Rescue Association clinics in Pheriche and Manang. Other destinations considered.

Catherine Mangham has sent in her account of running the Bob Graham Round:
Thanks for all the efforts to get supporters and for the good wishes.  It all paid off when the torrential downpour at 8am, when we set off, turned to sunshine, excellent visibility and a cool breeze for the rest of the day.  Gill Irvine and I had great people helping out, one of whom Katy will remember from her first go with Jo Mclintock...David Owens.  He took us over the night section across the Helvellyn ridge with amazing accuracy, he knew the shape of every summit cairn so we didn't hit the wrong ones.  We only needed our torches for the descent from Clough Head as the sky was so light.  I now know what sheep do at night.....just the same as what they do during the day!
We got ourselves over the Honister Pass to Wasdale leg, and lost a bit of time wondering which cairns were which and going over them all, and the 3rd leg proved the hardest.  Gill hadn't eaten or drunk enough at that point and my knee, bad from the LAMM 2 weeks before, was starting to really scream over the rough stuff.  I had decided to give up as we only had 1 person scheduled to take us through the night and I didn't think I would make it, but Gill's sister, Chris and husband Ron, had drummed up more folk from the local fell running club, so there was no excuse!! 
We got to the top of Skiddaw with guts and knees intact at 5:50am, in time for the most spectacular sunrise pinking up the hill ahead....which was the only good thing about that ...XXX@@@ hill.  but my knee was excruciating on the path down and it took over an hour to get into Keswick.  Gill very kindly stuck with me, as she probably could have managed 22 hours 30mins otherwise.  As it was we got in at 22hours 58minutes.
We both reckon that is the biggest day out we have ever done or likely to do!!!  One of the supporters, Joe, pointed out where we had been from the top of Skiddaw and I nearly died...what a spectacular place and wonderful people.    NEVER AGAIN!!!!

Frederic DeClerk has sent this in: Hi everyone.  After leaving Kathmandu at the end of February, we spent 6 days trekking up to our new home for the next few months: the HRA clinic building in Manang. Gobinda and Indira, our nepali helpers accompanied us together with 20 porters (carrying the food, medicines for the clinic, cooking gas....) We arrived in Manang on the 2nd of March, and were promptly welcomed by the local mothers group with Tibetan tea and katas (milk tea, and white shawls) Our little clinic building was better than we expected. We had two rooms for the doctors, a kitchen, staff room, clinic room, and solar shower. even 24h electricity by solar power...great.
We were three doctors for most of the season: Jan and myself and an American doctor with his wife, both from Colorado Springs. This meant we could divide the work and take some time off to go walking in the area.

A routine day looked like this: breakfast at 7.30, (Indira, our cook made lovely pancakes, buckwheat pancakes, porridge,...), then we opened the clinic at 9.00, usually there were a few patients in the morning, nepali
and foreigners. but loads a time to read,...then lunch, then shower time (early afternoon is perfect timing: just enough for the solar shower to heat up and not yet any winds outside which make it very cold!! At 3.00 PM we hade our daily lecture to the trekkers. Very enjoyable At 5.00PM we closed the clinic and usually went to the village for some tea, chat with the villagers,... at 7.00Pm we had our daily dhal baat (rice with lentils) Luckily Indira had cooked for westerners before, so we were spared from three times dhal baat
a day... I apology if I speak about food a lot in this mail, but after four months without fresh vegetables, fruit or meat, we are a bit preoccupied. And it is the same with trekkers, it is amazing how many conversations in the evening turn out to go about food, what you will eat when you get back down, blablabla...
Mind you, we did manage to touch up our meals a bit. Once we had to arrange a helicopter for a rescue and the HRA in Kathmandu put some green vegetables and two packets of chicken on board.. Great
And two times the teachers in the village slaughtered a goat, so we had some of that too...

The medical problems we had were quite varied. Trekkers mainly came with diarrhoea and altitude sickness, while the locals had all sorts of problems, from chest infections to skin rashes to teeth problems to broken limbs. We had to arrange a few rescues for trekkers who were very ill with altitude sickness, and also had to plaster a few arms of nepali who fell from a roof or tree. And then there were the funny things, like the Israeli trekker who got hit on the head with a hammer after arguing over a 100rupee bill (50pence), or
the time we had to assist in the delivery of a foal (died). Or the farmer who asked for our help after he hit his ox on the head with a stone. Apparently the animal didn't want to plough anymore, so he took a
rock and threw it at it. It struck the ox right between the eyes and the beast collapsed, and hadn't walked since (it did get better in the end)

Luckily it wasn't all work, and we had some play. The Manang valley is beautiful and there were some great walks we did. We went up to the Thorong pass (5416m) a few times and visited Tilicho Lake, a high altitude lake at 5200m, we camped next to the lake, the following morning we were woken up by a shower of ice (our breaths had condensed inside the tent and promptly turned into snow....) One of the best walks we did was to the villages of Nar and Phu. These are in a valley parallel to Manang valley, but this was previously closed for
foreigners (the valley leads up to the Tibetan border). This year the government opened it and we were among the first foreigners to visit. We had to take our tent, food,... as there are no lodges... The trip ends with
crossing the Kang La pass at 5322m, from which we had a great view of the Annapurnas, Dhualagiri, Nilgiris, and back to the Tibetan Plateau.

We closed the clinic on the 20th of May and then continued the rest of the Round Annapurna trial, so went over the Thorong pass to the Holy site of Muktinath. Then on to Kagbeni, where we stayed in a lodge (Red house) that has its own little gompa inside (complete with 2m high buddha statue!!) We then went down the Kali Gandaki valley - said to be the deepest gorge in the world ( Annapurna - 8000+m on one side, Daulaghiri 8000+m on the other...) We stayed in some lovely places, but as we were walking downit became
hotter, and hotter, and hotter. In Tatopani (tato=hot, pani=water) we visited the hot springs (and had an ice cold coke while lying in the warm water, ... very cool) We then completed our walk with the long climb up to Poon Hill from which we had a great view from Annapurna, Dhualagiri, Machapuchhre,... in the
morning (had to get up at 4.00AM though... We finished the walk in Naya Pul, and then came the most dangerous part of the walk:... the taxi ride to Pokhara. Cramped in a small Toyota corolla, with lots of scratch marks from previous hits, our driver dodged other taxis, buses, and lorry and seemed to be on a personal mission to not hit the brakes once and to keep the horn on at all times.... The joys of Nepali
traffic... Luckily Pokhara was not too busy, it's much more relaxed than Kathmandu, but hot, oh so hot. We spent a few days there relaxing, took a boat ride on the lake, and re-stocked on vitamins with lots of fresh fruit (mango, pineapple, bananas, lichis,...)

We finally arrived back in Kathmandu on the 31st of May. (after another enjoyable bus ride on nepali roads, with a few Indian people who were nearly killing each other for the best seats, heated arguments,... all worse because the air-conditioning didn't work...)

We are now winding up here, had our goodbye party at the HRA last night. (and got to write our name on the famous Rum Doodle pub wall - where all  the Everest summiteers have written too). We are flying home on the 9th of June, a little earlier than before. The last few days, we will spend visiting Baktapur and Patan, famous cities, and maybe taking a rafting trip or so...

Phew, now I've got cramps in my fingers from typing, hope you're not dozed off by now. Hope to see as many of you as possible when we are back in Europe.


A few events organised by the Britain Nepal Society that members might like to know about:
Weds Sept 17, Royal Geographic Society - Lecture by Mark Tully in aid of Nepal in Need Trust
Tues Oct 7, Soc of Antiquaries, Major KBS Kent on the British attempt on the SW face of Everest in 1972
Mon Jan 19 2004, Soc of Antiquaries, talk by Dr Gillian Holdsworth of the Britain Nepal Medical Trust
For more details email Mark Howarth on

Peaks and Porters: Ogre to Everest   Lecture Tuesday, 11 November at 7.00 pm at the Royal Geographical Society by Doug Scott, OBE and Ben Ayers. Introduced by Sue Lloyd-Roberts
Heroic tales of the Himalayan mountain porter, including Doug’s epic journey off the Ogre and Ben’s update on Nepali porter culture. Fund-raising event for Community Action Nepal, Porters Progress and the Hopeful Home for Helpless Children and Orphans, Kathmandu. Tickets: £10. Send cheque (payable to IPPG) with s.a.e. to Porters Progress lecture, IPPG, 3 Northfields Prospect, Putney Bridge Road, London SW18 1PE or telephone 020 8870 2600. This has been organised by Medex Member Denise Prior after being inspired to help Porter's Progress during Medex 2003. Please make every effort to attend. It is an excellent and needy cause.

Medex West Nepal 2007

Below is a draft outline of our 2007 expedition

Outline maps are already published on our website and we are developing a picture library of the trek.

Kathmandu - Pokhara - Jomsom - Mustang - Jomsom - French Pass - Dhualagiri Base Camp - Phala Gaon - Jalja Pass - Thankur- Tarakot - Dho Tarap - Numa La - Ringmo Lake - Kagmara pass - Hurikot - Jumla -  Bumri - Rara Lake - Sinja - Jumla - Pokhara - Kathmandu

Other variation: Kathmandu - Pokhara - Beni Phala Gaon - Jalja Pass - Thankur- Tarakot - Ringmo-  Kagmara pass - Hurikot - Jumla - Pokhara - Kathmandu (avoids the expense of Mustang)

Other entry points for those with less time: Beni, Juphal and Jumla.

Maximum duration ex Kathmandu 60 days

Minimum duration ex Kathmandu 21 days depending on joining point

For our fourth major Expedition to Nepal we have broken the mould and devised a highly unusual and challenging route. Instead of a traditional trek in, climb high and trek out expedition we, in autumn 2007, will begin in the Kali Gandaki valley and trek westwards along the spine of the Himalaya. As usual this Expedition will have trekking, research and mountaineering objectives.

As yet we have not defined our mountaineering objectives as we will have to negotiate access to the various peaks that we will pass. Below is an outline of our trekking route. There are many variations so it is easy to keep groups geographically separate and still meet up for regular shared camps. Some regions require special permits and liaison officers and it is possible for groups on a low budget to avoid these if necessary. For those with less time available it is possible to join or leave early from the various air strips we pass en route. For those wishing to avoid the higher elevations they could join just for the start (Mustang) or at the end (Rara Lake).

Though we inevitably will have to spend some time in Kathmandu on this Expedition we plan to spend several days in Pokhara at both the start and the finish. For those able to devote the full 60 days to the Expedition the first 10 days  will be spent visiting Mustang. We begin here as it is unaffected by the monsoon and so it enables us to start trekking earlier than we would otherwise. Mustang is relatively low and should enable us to gradually acclimatise before turning westwards over the French Pass to Dhualagiri Base Camp. For those with less time available they would drive to Beni and trek south of Dhualagiri to a rendezvous with the First group at Phala Gaon.

From there the route goes west over 2 passes and through very poorly mapped country to the village of Tarakot. The views of Dolpo from the pass before Tarakot are said to be "exquisite".

From Tarakot the groups will again diverge. Those with time and those able to afford the Dolpo permit will trek north east into the heart of Dolpo before turning west again to the next rendezvous at Ringmo to camp for a few days R&R on the shores of Lake Phoksundo. Others may wish to trek direct to Ringmo and thus avoid some expense. Groups with less time available may wish to join the main Expedition at Tarakot by flying to Juphal.

From Ringmo the route goes once again west to the next rendezvous at Jumla where there is a further air strip allowing others to join for the final Rara Lake leg. The 10 day circuit goes to Nepal's least visited National Park, is at relatively low elevation with a maximum altitude of 3,800m and is inhabited only by park wardens and wild life. From Jumla the groups fly back for some serious R&R at Pokhara.

Based in Pokhara for the final few days of the Expedition there will be opportunities to chill out on the lake, go parapenting or raft the river down to Chitwan.

Full details and prices have yet to be worked out. Visiting Dolpo and Mustang will be made expensive by the need for special 10 day permits. The logistics will undoubtedly be very complicated with several different portals for groups and several "transit type camps". These camps are an new innovation for Medex and will provide opportunities for groups to catch up, to socialise and to do research. It is envisaged that much of the research will be done on the hoof with compact, light weight equipment and solar power supplies. This is in contrast to our previous centralised base camp model. The trek profile will pose considerable difficulties for the researchers too. As stated above we are unsure of the mountaineering objectives but the route passes many peaks in the 6,000 to 6,500m range that look suitable.

As with our 2003 trip it is likely that politics will play a significant part in the difficulties. The Maoist movement began in the West and there is no way of predicting what circumstances will be like in 2007. What is certain is that this is a remote, rugged and seldom visited region, many areas of which were only opened to westerners in 1992. Permits will make aspects of the trek expensive and it is likely that there will be considerable bureaucracy as we will be close to the Tibet border and in prime Maoist country. The logistical and research challenges will also be severe. All this adversity should, however, make this one of our most rewarding Expeditions.

Medex Antarctica 2006
This a completely new venture for Medex and represents a personal fulfilment of a lifelong ambition. The Expedition will take place in January and February 2006 and will combine the thrill of sailing from Tierra del Fuego across Drake's Passage with the adventure of skiing and climbing in one of the remotest destinations on earth.
In 2000 Sally and I went down to Patagonia with the express purpose of researching the feasibility of this trip. We experienced, first hand, just how inclement the Patagonian conditions can be and so are under no illusions as to how unpleasant the voyage past Cape Horn to the Antarctic Peninsular may be. However the rewards of arriving in this incomparable wilderness by small yacht are huge. We will cruise down the Peninsular in the relative shelter of the archipelago to the west of the Peninsular until we get into the ice. We will then be dropped off by the yacht and establish a land Base Camp on the ice. From there will climb ski and trek before being collected and transported to the next land base.
After approximately 4 weeks on the ice will turn and head north back to Tierra del Fuego. The crossing of Drake's Passage takes about 5 days and thus the total Expedition from Tierra de Fuego to Antarctica and back will be 6 weeks. It does, of course, take at least 2 days to reach Tierra del Fuego from the Northern Hemisphere and so realistically 8 weeks leave are required.
As alluded to above this is an extremely remote Expedition with no chance of outside rescue and should only be contemplated by those that are capable of travelling competently on glaciers. Those that choose to ski must be experienced ski mountaineers and those that choose to climb must be very experienced.
The voyage to Antarctica crosses one of the most tempestuous pieces of water in the world. It is euphemistically referred to as the "screaming fifties". Though the yacht will be chartered complete with crew and will be designed for sailing in this region the journey south will be an uncomfortable one. Some sailing experience would be very valuable if only to have first hand experience of sea sickness and how to cope with it.
Medex is able and willing to arrange glacier and sail training for those keen to undertake this Expedition.
As with all expeditions to Antarctica this will, inevitably, be an expensive one. We will charter a yacht from one of the specialist companies providing expedition support based in the Beagle Channel. It is thought that this trip will cost in the region of £10,000 which would not include airfares, equipment and freight. As yachts get booked up years in advance an early expression of interest is essential.

Medex Membership - New Subscription Period:

Medex was formed in 1998 and the membership programme has proved far more successful than anticipated. Currently (August 2003) we have 270 paid up members. The new subscription period will run for 4 years and will cost £45. Please note that Medex Membership no longer includes associate membership of the BMC. We hope that members will feel that this provides good value for money.

Newsletters will be sent out by email only. If you require a postal version you will need to specifically request this and pay a £10 surcharge.

Pay either by cheque or direct bank transfer into the Medex account: Lloyds Bank, Pride Hill, Shrewsbury UK. Sort code 30-97-62  account number:  01919643   Code: LOYDGB2L. Please be sure to quote your name. Unfortunately at present we do not accept credit cards.

Old Dungeon Ghyll in the English Lake District October 2003

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.

Pay either by cheque or direct bank transfer into the Medex account: HSBC Bank plc, Wolverhampton PO Box 33. Sort code 40-47-11 Account Number: 12183293

Medex Ski trip to Chamonix 4th - 8th March  2004

A  first for Medex. Taking advantage of cheap flights to Geneva from the UK it is now possible to have an excellent and inexpensive long weekend in Chamonix. Sally and I will take a late flight to Geneva on the Thursday and stay at the Hotel Beausoleil in the tiny hamlet of Le Lavancher (half way between Chamonix and Argentiere). We fly back from Geneva on the evening flight thus allowing 4 full days skiing.

This picturesque family run hotel is ideally placed to ski any of the valleys ski fields. If conditions are suitable Sally and I hope to ski the world famous Vallee Blanche which is the longest, finest and most accessible off-piste ski run in Europe.

If you would like to join us then please make your own travel and accommodation arrangement. The Hotel Beausoleil is very reasonably priced. It's probably best to share a hire car from the airport as it is very useful to have you own transport in Chamonix for the weekend.

We neither supply guides nor tuition for off piste routes though both can be hired in the Valley. Hotel email:

U.I.A.A. I.K.A.R. I.S.M.M.
The first UK Diploma of Mountain Medicine will be open for applicants from November 2003.

The Medical Commission of the International Mountaineering and Climbing Federation (UIAA Medcom), International Commission for Mountain Emergency Medicine (ICAR Medcom) and International Society of Mountain Medicine (ISMM) have been running an internationally recognised Diploma of Mountain Medicine in France, Germany, Switzerland, Spain and Italy for several years. It consists of a basic international syllabus that is then adapted to the needs of each member country.

At the UIAA Medcom meeting in Kathmandu in 2001 the two UK British Mountaineering Club (BMC) representatives were asked to look at the need for a UK version of the Diploma. Initially sceptical about another “mountaineering qualification” they were won over by the very practical basis of the syllabus and the obvious enthusiasm of their European mountaineering medical colleagues.

The Course: The UK Diploma is being run on a modular basis with a course logbook similar to the tried and tested system currently used by the UK Mountain Leadership Training Boards. The personal logbook will contain sections on pre course experience (both medical and mountaineering), each course module and, most importantly, continuing post course experience.

The syllabus includes sections on the physiology of exercise and high altitude, expedition and travel medicine, pre hospital care of trauma and illness in a hostile environment, first aid, patient transport and an introduction to mountain rescue techniques. Candidates will be assessed by UIAGM guides on their ability to look after themselves in the mountains during the UK summer, Scottish winter and Alpine modules. In addition there will be a spring theory module held in Snowdonia with time to get out in the hills. The international syllabus has an emphasis on the needs of Alpine rescue doctors but this has been adapted to UK conditions to cover more travel and expedition medicine for doctors working for commercial expedition companies. It also covers the unique conditions that are often found in Scotland in the winter.

There will be a self directed distance learning aspect to the course with constant assessment but the four residential modules can be spread over up to four years. It is hoped that the UIAA/IKAR/ISMM Diploma will be accepted by the University of Leicester Medical Postgraduate Department as an UK academic Certificate, with the possibility of upgrading to UK academic diploma level by the addition of a dissertation. Further Details can be obtained from:


That's enough for now please remember to renew your Medex Membership and do make every effort to join us at the Old Dungeon Ghyll and in Chamonix.

Simon and Sally