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Teaching Wilderness Medicine in the Khumbu

Monday, January 14th, 2019

Tragedy and Purpose

In September of 1999, legendary mountaineers Alex Lowe, Conrad Anker, and David Bridges traveled to Tibet with the goal to ski down the 8,103 m (26,291 ft.) Himalayan peak Shishapangma.  They were part of the 1999 American Shishapangma Ski Expedition. The goal was to be the first American team to ski from the summit of an 8,000 m peak.

Bridges, Anker, and Lowe (left to right)

Unfortunately, tragedy struck on October 5 as they were searching for a route up the mountain.  A large serac broke loose 1,800 m (6,000 ft.) above them, resulting in an avalanche striking all three of them.  Anker survived with multiple injuries, and immediately began attempts to locate and rescue his friends. With the help of others, Anker searched for his teammates for the next two days. Unfortunately, they were unable to locate Lowe and Bridges.

Lowe was survived by his wife Jennifer and their three sons.  Following this tragedy, Anker spent a great deal of time with Jennifer and her three sons.  During this time, the two fell in love and were married in 2001 (Jenni Lowe-Anker wrote more on this in a memoir, it is also discussed in the film documentary Meru).  Together they formed the Alex Lowe Charitable Foundation.  The Khumbu Climbing Center, or KCC, is a result of this foundation and where many of their efforts are focused.

The Khumbu Climbing Center

Located at around 3,960 m (13,000 ft.) in the Khumbu Valley, Phortse is a humble pastoral village that is home to generations of Sherpa climbers and to more Everest summiteers than anywhere else on earth.  Phortse lies off the traditional beaten path to Everest and is often overlooked, as it lies perched among the clouds resting in the shadows of the sacred Himalayan peaks. But if you look across the gaping gorge of the Dudh Kosi River as you ascend to the Tengboche Monastery, you will see a terraced knoll with stone structures scattered about.  It is there that the Khumbu Climbing Center found its home.

Khumbu Valley with Photse visible

Phortse (left mid flat area) with Everest, Lhotse, Nuptse, and Ama Dablam in background

The KCC was founded in 2003 with the mission statement “to increase the safety margin of Nepali climbers and high-altitude workers by encouraging responsible climbing practices in a supportive and community based program.” For 2 weeks each winter, technical climbing skills, English language, mountain safety, rescue skills, mountain geology, and wilderness first aid are taught to students.  Prior student experience ranges from novice climbers/porters to Everest veterans, and to even the famed “Ice Fall Doctors” who painstakingly and courageously find a way through the Khumbu Icefall each climbing season to open the path towards the sacred summit of Sagamartha (Nepali name for Everest).  To date, over 800 students have benefited from this annual vocational training aimed to improve both their quality of life through better employment opportunities and their ability to stay safe as they work high in the Himalayas.

In addition to the annual training that occurs, the KCC has also offered specialized courses over the years including advanced technical rescue and advanced mountain first aid.  The KCC is dedicated to the village of Phortse and over the past years and with countless help, has tirelessly worked to build a permanent building in Phortse.  This building, which is nearing completion, will serve as the home to the KCC and will allow for expanded instruction, will provide access to both visiting Nepali and international climbers year round, and will also serve as a community center, library, and medical clinic for Phortse.  It is but one way that the KCC demonstrates their dedication both to the Phortse and all high altitude workers of Nepal.

Discovery, Reunion, and Collaboration

On April 27, 2016, climbers Ueli Steck and David Göttler were on an expedition to Shishapangma when they spotted two bodies that had partially emerged from the glacier.  Suspicion was high that they were those of Lowe and Bridges.  Shortly after, Anker’s phone rang with news of the discovery and after a description of the bodies, their clothing, and equipment, Conrad and Jenni were convinced that it was indeed Alex and David.

In response Anker said, “It’s kind of fitting that it’s professional climbers who found him. It wasn’t a yak herder. It wasn’t a trekker. David and Ueli are both cut from the same cloth as Alex and me.”

Regarding this discovery, Jenni Lowe-Anker said, “I never realized how quickly it would be that he’d melt out…I thought it might not be in my lifetime.”

Meanwhile in New Mexico, Dr. Darryl Macias, an emergency medicine physician who specializes in mountain/wilderness medicine, was returning home from teaching a wilderness medicine and dive course in Hawaii when he received a phone call.  “Ueli Steck found them!”

Dr. Macias and David Bridges were very close friends and climbing partners that had traveled the continent and Europe together.  Part of Dr. Macias’s desire to focus on, teach, and promote wilderness medicine was inspired and spurned by the death of his close friend David.  Soon after, Anker and Macias contacted each other along with others close to Lowe and Bridges.  Plans were made to travel to Tibet to lay the two to rest, with Dr. Macias serving as the expedition physician.

Shishapangma expedition to recover Alex and David

While emotional, the trip was a success and the group was able to locate Alex and David and lay them to rest according to local custom and practice.  During this trip, Dr. Macias learned about the KCC, its mission/purpose, and was invited by Anker to come and teach at the KCC.   With great enthusiasm, Dr. Macias accepted the invitation and traveled to Nepal in January of 2018.  He traveled there with two other physicians from the University of New Mexico International Mountain Medicine Center, Dr. Jake Jensen and Dr. Hans Hurt, to provide much needed medical education to the amazing group of high altitude workers that call Nepal their home.

(For more on Dr. Macias’s experience dealing the loss of a friend, his journey and experience into wilderness medicine, and his experience at the KCC see his MEDTalk. He starts at 1:31:00.)

Albuquerque to Phortse

Prior to departing, we (Macias, Jensen, and Hurt) discussed what topics we felt would most pertinent for the course. We knew that we would only have 8 hours with each group of 8-10 students, and wanted to ensure that all the information taught would be beneficial.  While we knew we could cover topics such as acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, and hypothermia, we also wanted to teach more commonly encountered conditions.  We reviewed the current literature to make an updated list of the most common complaints encountered during expeditions and treks.  Ultimately, we created a small booklet full of illustrations and diagrams that was written in simple English for each student to keep. The booklet contained topics we wished to teach, along with extra topics we knew we wouldn’t have time to cover.

After traveling halfway across the world from Albuquerque to Kathmandu, we met with a small group of other KCC western instructors and flew to Lukla together.  Lukla is often referred to as the gateway to Mount Everest, as most expeditions into the Khumbu region start there.  It is also home to the world’s “most extreme and dangerous airport” as it lies perched on the side of the steep valley amongst 6,000 meter peaks.  From there we began our 3-day trek to Phortse, stopping in Phakding and Namche Bazaar along the way to acclimatize.  We also enjoyed great views of Everest, Nuptse, Lhotse, Ama Dablam, and countless other peaks, often sipping “chiya” at quaint tea houses.  Our arrival to Phortse was a humbling one, as many locals were waiting at a stupa, which marks the entrance into the village.  We were warmly welcomed with cheers, hugs, and khatas (long flowing silk fabrics to adorn the neck) to mark our newfound friendship.

Entering Phortse

Shortly after arrival, the preparation began for the biggest group of students that KCC has ever had.  We assisted in teaching advanced climbing skill updates to the Nepali instructors and gave them a medical refresher course, as it had been years since many of them had received any form of medical training.   This also gave us a chance to test out our teaching strategies using various scenarios, demonstrations, and discussions prior to students arriving.  Based on their feedback, we made minor adjustments and added a few additional topic ideas to benefit the students.

For the remainder of the course, we taught students basic first aid in groups of 8-10 each day.  We began with personal safety, scene size-up, and going over the MARCH algorithm.  Other topics included wound care, blisters, orthopedic injuries, altitude illness, hypothermia, frostbite, and GI issues.  We opted for topic discussions, demonstrations, scenarios, and hands-on activities, eliminating standard PowerPoint presentations.

Jake Jensen and Hans Hurt teaching scene size up and safety

We found that many students understood English, though with variable fluency. With each class we taught we learned more Nepali, making our teaching even more effective.  At times our Nepali words were not perfect, making for many laughs (the Nepali word for knee is very close to a very different part of the male body). However, they understood us, and appreciated our efforts to use as much Nepali as possible.

Darryl Macias teaching how to splint

Each day to start we would have the group introduce themselves to us.  We would ask where they were from, what their medical training background was, and what their experience was working in the Himalaya. Through this, we found that only around 10% had had some form of medical training in the past.  This number was lower than the number of students that had climbed or been on expeditions to Everest and other 7,000 meter (~23,000 foot) and 8,000 meter (~26,000 foot) peaks.  This solidified the importance of our medical course, as for many it was the first formal medical education they had ever received, and it may be the only training some students ever receive.

Darryl Macias and Jake Jensen giving a lecture

Our main focus in teaching was in line with the mission statement of the KCC.  We continually emphasized safety and self-care during every topic we taught. Overall, our instruction was very well received and students did exceptional during the test day, demonstrating that safety was of the utmost importance in caring for ones-self and others.

We enjoyed our time in Nepal, and were glad we could contribute to the cause.  We were all humbled by the experience, and developed a deeper appreciation, respect, and love for the people, culture, and landscape of Nepal.  We all looked forward to a chance to return, unsure when that would be, and discussed how we could improve their education, preparation, and discussed the idea of teaching a Wilderness First Responder course to the more advanced individuals if we were presented the opportunity.

Macias, Jensen, and Hurt in Tengboche with Ama Dablam and Everest in background

We even recorded a podcast for the Wilderness Medicine Society, Wilderness and Environmental Medicine Live! where we discussed our experiences (starts at 20:03). We all looked forward to returning, but weren’t confident when we would have that chance…

The Return

As plans were being laid for the 2019 KCC course, Dr. Darryl Macias and I were contacted by the directors of the KCC.  We were happy to hear they were pleased with our efforts the year before and asked us if we would return.  We jumped at the opportunity, happy to take what we had learned the year prior to improve the education provided.  We would also take with us Dr. Nicole Mansfield, our current Wilderness, Austere, and International Medicine Fellow.

In addition to teaching a one day basic medical course to ~90 students, we were also asked if we could provide a Wilderness First Responder (WFR) course to ~24-30 of the local KCC instructors who also serve as guides throughout Nepal.  Many of them had approached us the year prior with great interest in a WFR course and we eagerly accepted this invitation to provide them with additional instruction.  While there have been other Wilderness First Responder courses taught in the Khumbu Valley, this would be the first aimed to educate the local population that call it home.

Plans were made regarding how we could improve the education to the basic class and a curriculum for the WFR class was developed.  We created an online video library for the WFR students so they could start their learning prior to arrival.  We also began gathering the supplies that we would need to teach.  It was during that time that we realized that it would be best if we could provide them with a medical kit that would match their level of training.

After reaching out to many individuals and groups, we were thrilled when Adventure® Medical Kits responded and stated they would assist us by providing medical kits to the 24-30 local Sherpa guides that we would be teaching a WFR course to.  These kits, the Mountain Series Explorer, will be the perfect kit for this group.

The Explorer medical kits in the hypobaric chamber

The contents of the kit are excellent and is ideal for the WFR training that this group will receive. This donation will go a long ways to ensuring that this group doesn’t just have the knowledge, but also the tools to care for others in a wilderness/remote environment should the need arise.

Darryl Macias in the hypobaric chamber, supplementing kits with extra gloves and gauze. 

In addition to that, we also received additional funding from another source and will be able to provide very basic medical supplies to the ~90 basic class students and will also be able to add some supplies (survival, fire-starting equipment) to the kits provided to us by Adventure® Medical Kits for the WFR students.

Jensen kids making small kits for basic class students

Things have been extremely busy as we search out the equipment we will need to teach, record videos, refine lesson plans, and gather personal gear, but all in all this year is shaping up to be a fantastic one at the Khumbu Climbing Center, and we cannot wait to arrive and provide this much needed education to this amazing group of individuals.  Stay tuned for a follow up on how things went!

Packing the Explorer medical kits and other supplies

About the Authors

Jake Jensen, DO, DiMM, FAWM

Jake Jensen is an emergency medicine physician who completed a Wilderness, Austere, and International Fellowship program with the University of New Mexico. He enjoys teaching wilderness medicine at all levels and has also practiced and taught medicine in Haiti, Chile, and Nepal with plans to continue teaching nationally and internationally in the future.   He has a very loving and supportive wife who puts up with his antics, travels, and hobbies.  He also has 4 adventurous children that love the outdoors, help him pack for his trips, and look forward to when they can travel more with him.  In his limited spare time he enjoys backcountry skiing, mountain biking, backpacking, and simply sitting around the camp-fire.

Darryl Macias, MD, FACEP, DiMM, FAWM

Darryl is a professor of emergency medicine at the University of New Mexico International Mountain Medicine Center. He has been involved in wilderness and international emergency medicine development in Latin America, Europe, and Asia, and has lectured internationally. He is involved in mountain rescue and expeditions, but also enjoys taking his family on crazy trips throughout the world, seeking new adventures in life. You can hear his lively Wilderness and Environmental Medicine LIVE! Podcasts on iTunes and SoundCloud.

More Information

For more information on the Alex Lowe Charitable Foundation and the Khumbu Climbing Center, click here.

To learn more about discovery of Alex Lowe and David Bridges on Shishapangma (also where quotes from Conrad Anker and Jenni Lowe-Anker were found), click here.

Below are the links mentioned above in the blog post along with a few additional ones. Highly recommend you take a look/listen at these.

Dr. Macias’s MEDTalk regarding his story of loss, journey into wilderness medicine, and what the future holds.  Starts at 1:31:00.

Link to the Wilderness and Environmental Live! Podcast where we discuss our experiences during our first trip to the KCC. Starts at 20:03.

Link to the Wilderness and Environmental Live! Podcast where we have a discussion, with the authors, regarding a recent paper that was published regarding the knowledge of porters in the Khumbu Valley when it comes to recognition and treatment of altitude illness. We also branch off and discuss other aspects of medicine and their well-being. Start at the beginning.

Link to The Mountain Dispatch, a biannual newsletter put out by the UNM International Mountain Medicine Center where we discuss last year’s trip to KCC.