The Mountain Heroes

Features Issue 151 Jun, 2014
Text by Prabal Shrestha

Living on thin air, the Himalayan Rescue Association and its volunteer doctors have saved numerous lives, while risking their own. Past its 40th year, the HRA’s journey encapsulates numerous tales of efforts to tame the untamable.

On 18 April, at around 8:00 in the morning, Prakash Adhikari, the Chief Executive Officer of the Himalaya Rescue Association (HRA), was informed that an avalanche had struck near the Everest basecamp at 6:45 am. “As soon as I got the news, I shared it with the chairman and the medical director, then we discussed the situation with the Home Ministry, the Tourism Ministry, and the Nepal Tourism Board (NTB),” he says.

At the same time, their team at the basecamp — two Nepali doctors, a foreign doctor, and a local staff — were preparing for the casualties. The local staff, who had also been trained for search and rescue efforts, was also involved in the rescue operation. A team of nearly 50 trained climbers went to the avalanche site at a height of around 5,800 meters, 450 meters above base camp, to participate in the efforts.

“At first the news was four dead, some missing… then six dead, some missing… and later twelve dead,” says Adhikari. By the end of the rescue operation, sixteen were found to be dead with four survivors.

As the rescue mission was underway, the other HRA team at Pheriche health post —three foreign doctors and two Nepali staff— were informed of the incident. At 4,250 meters, Pheriche, a small village en route to Everest base camp, is where the first HRA health post was set up in 1973, initially carrying out services from a yak-shed. Today, the post is properly equipped, the best among the HRA’s health posts, and has its own building. It was certain that the casualties would be brought to Pheriche after they’d been taken to the basecamp health post.

At mid-day the search and rescue efforts were halted, as the risks of a second avalanche arose. The four survivors and the dead bodies that could be recovered were brought down to the health post at base camp. After immediate medical attention, the casualties were flown to Pheriche on a helicopter. There, the efforts of the doctors and the assisting staffs helped one of the survivors recover, while the remaining three had to be taken to Lukla for further medical attention.

The tourism ministry was the official spokesperson, but we also played a role in disseminating information, especially those that were related to medical issues,” says Adhikari, explaining one of the other roles that the HRA played after one of the deadliest avalanches on Everest. “The incident was very sad, but it was beyond any man’s control. However, I believe we performed our duty. Our doctors, nurses, and staff did all they could to provide timely medical attention to the surviving casualties,” adds Adhikari.

Annually, nearly 150 individuals are evacuated from HRA’s health posts in Pheriche, Everest Base Camp (seasonal health post), Manang, and Gosaikunda (annual health camps). “4,500 patients and casualties are brought to our health posts and camps every year, of which seven out of ten are Nepalis, and around six out of ten are trekkers suffering from altitude sickness. And in the twenty-years I’ve worked for HRA I can recall only one fatality from altitude sickness,” says Adhikari.

The early days
Forty years ago, when Tek Chandra Pokharel was associated with Trans Himalayan Trekking, the picture was different. “During the sixties, trekking started to gain popularity in Nepal, and by the seventies it had gathered quite a momentum,” says Tek Chandra Pokharel, now an active eighty-year-old man, who is still running a trekking company, Shangri La Tours, with his son. “Deaths, however, were quite common.”

Around that time, many international organizations were being set up in Nepal, bringing many foreign volunteers. An American Peace Corps volunteer, John Skow, was bothered by the cases of altitude sickness among the trekkers during his trek in the Khumbu region.

“John Skow came back to Kathmandu, and called upon various people from the embassies, ministry, and trekking companies, and put forward the issue. Some of the people actively present in the meetings, as far as I can remember, were Mike Cheney, Jim Edwards, and Jyoti Khanna. There were others whose names I can’t recall right now. And there was me. We all agreed that something needed to be done, which is how HRA came into being,” says Pokharel.

In 1973, the Himalayan Rescue Association was established as an NGO, with the sole intention of reducing casualties on Nepal’s mountains.

At the time, a doctor named John Dickinson was interning at Shanta Bhawan Hospital (Patan Hospital). In search of a doctor to volunteer for the task, Dickinson was contacted by John Skow. Dr Dickinson handled most of the early Acute Mountain Sickness (AMS) cases and went on to write the first “leaflet” on AMS for the HRA.

Skow’s term in Nepal came to an end, and he had to return to America soon after. Pokharel took the task of forming the Himalayan Rescue Association upon himself and became the founding chairman of the organization.

With virtually no money in the organization, Pokharel offered HRA a small space in the Trans Himalayan office at Durbar Marg, opposite Annapurna Hotel.  “It was a small table for a single staff. All the other resources were shared with the trekking company,” says Pokharel. Nepal Mountaineering Association (NMA) and Trekking Agents Association of Nepal (TAAN), two of the premier organizations concerned with mountaineering and trekking, also had their desks within the same office, initially.

The first health post was built in Pheriche. “We chose Pheriche because we realized that the maximum number of cases of altitude sickness happened around that area at 14,340 feet. Every year seven to eight people were dying near Pheriche,” says Pokharel. “One of the most infamous incidents was the death of the then Indian Ambasador, Harishwore Dayal, in 1964. He succumbed to altitude sickness during a trek in Khumbu.”

A French nurse, Danielle Laigret, volunteered to operate the clinic, which essentially only provided information on AMS and some basic medical assistance from a yak-shed. A local named Tashi Sherpa, recommended by Tony Hagen, a writer and anthropologist, was appointed as the Clinic Manager. In autumn of the same year, Dolly Lefever from the US and Dr. John Winter volunteered at the post. Despite the high number of cases, it was the first time that there were no fatalities amongst the patients who managed to reach the clinic.

In the 1974, Pokharel got well acquainted with a Japanese Professor from Tokyo Medical College—Yoshihiro Hayata—who used to visit Nepal for treks on a regular basis.“Mr. Hayata used to come through our company, and he was well aware of the issue of altitude sickness. He later got us funds worth $25,000 to build a high-altitude trekkers’ aid post at Pheriche,” shares Pokharel. With the amount, a proper building was constructed for the Pheriche health post, moving it out of the yak-shed.

Besides the contribution from Tokyo Medical College, aid from other volunteers, as well as patients, was helping the organization sustain and grow. The volunteers would go back to their home countries and collect funds, and return to volunteer the next season. HRA was also selling souvenirs and t-shirts to raise funds.  “After the first few years, money became less of an issue,” says Pokharel. “However, there were few incidents where, after being rescued and admitted in a hospital, the trekkers would leave without paying, leaving us to cover the expenses,” adds Pokharel with amusement.

“The first equipment that we bought was a diver’s decompression chamber. The machine was too big to even fit in the helicopter. We had to cut it in half, take it separately, and join the two parts in Pheriche,” shares Pokharel, reminiscing about the initial challenges. In the next few years, HRA got a simple and portable low-pressure hyperbaric chamber, as suggested by Peter Hackette, the then Medical Director, and Jim Duff, a volunteer doctor.

After the support from Tokyo Medical College, Japanese volunteers and researchers started to fly in and researches on the effects of AMS were conducted. “Before that there hadn’t been any kind of research on the effects of AMS,” claims Pokharel. “We later came to find out that scientists from NASA had also volunteered at Pheriche, conducting studies on AMS. We weren’t told they were from NASA at the time, it was only later that we found out who they were.”

In 1978, Pokharel was followed by P.P. Prasai as the chairman of HRA. With the new leadership, the HRA office also moved into Prasai’s office in Thamel, opposite Kathmandu Guest House. Prasai worked closely with the British Embassy and secured donations worth more than £30,000, which led to the establishment of the Manang Rescue Post. He was also able to establish an information centre in Kathmandu with the support of the French Embassy. A radio link between Pheriche, Manang, and Kathmandu was also set up during his leadership.

The Present
The Pheriche health post has come a long way from the yak-shed where it started. The Pheriche Rescue Post is double the size with insulated walls, and has a wind turbine to provide electricity. The hospital has two wards for inpatients, three bedrooms for the doctors, and two for the Nepali staff. The building also has a room designated solely for research purposes. The hospital is considered to be the highest in the world. “We also provide assistance in dealing with other forms of acute medical problems, such as broken bones and fever, at the facility,” says Dr Buddha Basnet, the Medical Director of HMA.

At Manang, an important town in the Annapurna trekking route, HRA’s health post is operated by four doctors and two local staffs. On the day of Janai Purnima, at Goasikunda, HRA conducts a temporary health post with seven doctors and two Nepali staffs every year. Thousands of pilgrims trek to Gosaikunda on the day for religious reasons annually.

Starting from the spring of 2003, the 50th anniversary of the first ascent of Everest, a group of three doctors and a Nepali staff have been running health camps from April 1 to the end of May (end of the spring climbing season) at the base camp every year. The facility has provided medical assistance to over 1,800 patients and has organized over 150 helicopter evacuations.

Finding doctors to volunteer is also no longer an issue for the organization. “We have set a good track record, and we provide good exposure to our volunteers,” says Dr. Basnet. “We have our own orientation program where we prepare our volunteers on dealing with AMS cases, as well as preventing them.”

However, the numbers of volunteers are still dominated by foreign doctors; Nepali volunteer doctors are not readily available. “It’s hard to find Nepali doctors who would work for free in a difficult environment,” says Dr Basnet. In 2008, the Mountain Medicine Society of Nepal (MMSN) was set up to spread awareness on the issue of mountain sickness, especially amongst medical practitioners. “Today, young Nepali doctors are starting to show some interest in high-altitude sickness and also volunteering to gain exposure,” says Dr Basnet. “Through MMSN we are also advocating pilgrimage medicine. Similar to what HRA is doing in Gosaikunda, we want other pilgrimage sites to be addressed during important religious dates to minimize the cases of AMS,” says Dr Basnet.

Search and Rescue
In 1991, R.P. Pant, who is also a founding member of the Kathmandu Environmental Education Project (KEEP), took over the chairmanship. It was during his leadership that HRA started coordinating search and rescue efforts. In 1995, the organization coordinated search and rescue operations of 549 casualties in the Everest, Kanchenjunga, and Manaslu regions.

However, despite the name, rescue wasn’t on HRA’s main agenda. The organization was formed with the sole purpose of preventing casualties in the Nepal Himalaya, mainly focusing on AMS cases. “We can’t be rescuers. It takes a lot of resources to conduct rescue operations. And if you take the example of other countries, it’s always the government that takes charge of such undertakings,” says Bikram Neupane, who took over the role of chairman of HRA in 1999. The search and rescue operations are generally conducted by professional climbers appointed by the concerned trekking companies, and people from the government — the army and the police. The government hasn’t assigned an official body to lead the rescue efforts yet, which is why HRA has been stepping in to fill the void.

“I still remember an occasion when we were discussing plans to conduct a rescue operation after a major incident. There was an army general, a person from the Armed Police Force, and other concerned bodies. And they were all arguing about how to go about the operation. I took them all to a sekuwa pasal, prepared an agreement right there and then and brought everyone to a consensus,” says Neupane. “The role of rescue co-ordination was never assigned to us, we took the initiative. And after going through it a few times, we became the ‘rescue organization’ in Nepal.” For his rescue efforts after an avalanche on Kang Guru Himal on October 21 2005, Neupane was awarded the National Gendarmerie Medal and the SOS Medal by the French Government.

“The organization is building a new direction right now,” says Santa Subba, the incumbent chairman of HRA. “We are actively focusing on the rescue side of operations.” Subba has been advocating with the government for the use of GPS tracking systems for the past two years, but the organization’s efforts haven’t yet come to fruition.    

However, the prospects are not bleak. A statement echoed by Subba, Neupane, and Adhikari is that the HRA has always had good support from the ministries, embassies, the tourism board, and most of all, the NMA and TAAN. “Despite being a private organization, the government has always thought of us as their own, as we have been doing things that are difficult for the government,” says Subba.

Subba also has other plans for the organization. “Another immediate goal of the HRA is to set up a tourist emergency response center in Kathmandu,” says Subba, looking into the future. “In terms of extending our medical services, I think there is a need for health posts along trekking routes in Manaslu, Langtang, Kanchenjunga, and Muktinath.”

More people have summited Everest in the last five years than in the previous fifty-five, let alone the drastic increase in the number of trekkers to Everest Base Camp and Thorong La. In recent times, various new trekking routes in western Nepal have also been introduced. In forty years, the trekking scenario has evolved in an unprecedented way. In 1973, only 30 to 40 trekking agents were registered in Nepal, compared to the 976+ registered members of TAAN today. With these developments in the trekking and mountaineering industry in Nepal, risks are bound to increase. But what Adhikari has to say about himself and the HRA gives a glimpse into an organization that won’t back down in the face of a challenge: “Our job is to save lives. I could have chosen to be something else, but I ended working for a non-profit. Now my only dream is to build health posts in other parts of the country.”