Not to hate on our countrymen too much, but our first encounter with American trekkers was rather infuriating. In particular the guide, an accomplished climber and trekker himself, found himself saddled with a diverse group of trekkers including several elderly folks and then a couple of hyper-wealthy young hot shots. When trekking it is commonly held that your progress on the route is dictated by the health and wishes of the team. In other words, you work it out as a group, and base the decision on the health and goals of everyone in the team. Problems arise when you've got a few members weakened by illness and a few members who don't care about anything other than making it to base camp. So the guide dealing with this group came to us hoping that we would both talk sense into the hotshots that wanted to proceed without the rest of the team and then to help evacuate the weak links. He was very indirect in his requests and talked a big game of making a robust donation to the HRA for our efforts. We agreed to help by educating his group through the daily altitude lecture. Naturally, the two hotshots showed up about 20 min late and were generally uninterested. The rest of the group was quite responsive and inquisitive about the symptoms of altitude illness and many of them sought consultations for GI issues that they picked up on the way. In a funny moment towards the end of the lecture one of the hotshots asked about appetite and how to improve it (lots of people encounter poor appetite up here; improvement usually comes only with time). The guy had returned from a hike and a looked white as a ghost. Penny called him out, asking whether he was sleeping well because his face was looking pretty sickly. The hotshot mumbled some non-response, but the rest of the group got a kick out of it. Out a team of nine, the guide had the two hotshots, 3 sick trekkers, and the rest were in between.
The next day the guide came to the aid post mid-morning with probably the oldest guy in the group who had been suffering with gastro stuff (vomiting, diarrhea...a common occurrence up here) and after much deliberation decided to evacuate him. The patient was uncomfortable, no doubt, but stable and really just need some fluids and rest. Two other members of the group decided that they wanted to leave too. The general feeling from us was that these people were just tired of trekking. So the guide asked the HRA to coordinate the evacuation, which we were happy to do, but he proceeded to reside in the aid-post or leave and return every 5-10 minutes for an update. Now in the US such behavior might be expected since evacuations (most things, really) happen fast...but this ain't the US. Coordinating a chopper takes hours and then communication is very hit and miss. The insurance company has to agree to the evacuation usually requiring talking to us about the medical necessity. There is much negotiation of what company will get the job, and when the chopper would arrive. On top of that the weather in the valley is super dynamic. Dense, blinding fog can roll in to Pheriche (or anywhere between KTM and Pheriche) in minutes and stop up air traffic.
Because of limited phone service here, it is usually faster to let the HRA home office in Kathmandu do much of the coordination. While we were waiting for all the coordination to happen, we were still seeing other patients, giving the daily lecture, and our usual daily merchandise sales. The guide would not leave us alone and even called the HRA home office in an attempt to speed the process. He also did not seem to understand that we could not guarantee that the other two not sick people may or may not be allowed to ride along depending on the pilot and the weather. While we are of course happy to coordinate the evacuation, it takes more time than if Nepali-based trekking companies do it since they usually call the helicopter first and the insurance company later. The trekking company or whoever calls the helicopter also gets a 20-40% kickback, so they are quick to volunteer to do so. However, the helicopter costs more to cover this kickback and service. This American-based company did not want to involve their Nepali-based company, but seemed to expect the same service from us even though we had explained that that was not how it worked. We found it unbelievable that a guide with 15 years of experience in Nepal would be so unfamiliar with the evacuation process and so naive about the communication available in the mountains.
By 4:30 pm or so, the weather had clouded as it usually does, and the prospects of a helicopter seemed lower by the minute. Usually the helicopters stop in Lukla for refueling or other tasks, and at that point they call us to alert us to their ETA. We had not heard from them, since they left Kathmandu, so we assumed they were still not yet to Lukla, but suddenly we heard the helicopter through the fog and clouds and ran to get the patient. We got him on board and after some negotiation, the pilot agreed to take the other two trekkers. After even more negotiation, he agreed to also take all their luggage (which was more per person than we have for 3 months!) It seemed a small miracle.
However, the helicopter had not even taken off before the guide turned to us and began bitching us out for not having more notice that it was arriving and not getting the helicopter sooner. The nerve of some people! And he didn't even give us even a small donation much less the large donation he kept promising in front of his trekkers.
All we really wanted after that was a beer, but the obnoxious guide and the rest of the irritating Americans we in our usual tea house so we had a cup of tea instead. We were very disappointed in the attitude and actions of these American tourists and apologized multiple times for they way they had treated Arjun and our Nepali hosts. Some days, I wish we had Canadian passports.
H&C
March 28, 2013
The next day the guide came to the aid post mid-morning with probably the oldest guy in the group who had been suffering with gastro stuff (vomiting, diarrhea...a common occurrence up here) and after much deliberation decided to evacuate him. The patient was uncomfortable, no doubt, but stable and really just need some fluids and rest. Two other members of the group decided that they wanted to leave too. The general feeling from us was that these people were just tired of trekking. So the guide asked the HRA to coordinate the evacuation, which we were happy to do, but he proceeded to reside in the aid-post or leave and return every 5-10 minutes for an update. Now in the US such behavior might be expected since evacuations (most things, really) happen fast...but this ain't the US. Coordinating a chopper takes hours and then communication is very hit and miss. The insurance company has to agree to the evacuation usually requiring talking to us about the medical necessity. There is much negotiation of what company will get the job, and when the chopper would arrive. On top of that the weather in the valley is super dynamic. Dense, blinding fog can roll in to Pheriche (or anywhere between KTM and Pheriche) in minutes and stop up air traffic.
Because of limited phone service here, it is usually faster to let the HRA home office in Kathmandu do much of the coordination. While we were waiting for all the coordination to happen, we were still seeing other patients, giving the daily lecture, and our usual daily merchandise sales. The guide would not leave us alone and even called the HRA home office in an attempt to speed the process. He also did not seem to understand that we could not guarantee that the other two not sick people may or may not be allowed to ride along depending on the pilot and the weather. While we are of course happy to coordinate the evacuation, it takes more time than if Nepali-based trekking companies do it since they usually call the helicopter first and the insurance company later. The trekking company or whoever calls the helicopter also gets a 20-40% kickback, so they are quick to volunteer to do so. However, the helicopter costs more to cover this kickback and service. This American-based company did not want to involve their Nepali-based company, but seemed to expect the same service from us even though we had explained that that was not how it worked. We found it unbelievable that a guide with 15 years of experience in Nepal would be so unfamiliar with the evacuation process and so naive about the communication available in the mountains.
By 4:30 pm or so, the weather had clouded as it usually does, and the prospects of a helicopter seemed lower by the minute. Usually the helicopters stop in Lukla for refueling or other tasks, and at that point they call us to alert us to their ETA. We had not heard from them, since they left Kathmandu, so we assumed they were still not yet to Lukla, but suddenly we heard the helicopter through the fog and clouds and ran to get the patient. We got him on board and after some negotiation, the pilot agreed to take the other two trekkers. After even more negotiation, he agreed to also take all their luggage (which was more per person than we have for 3 months!) It seemed a small miracle.
However, the helicopter had not even taken off before the guide turned to us and began bitching us out for not having more notice that it was arriving and not getting the helicopter sooner. The nerve of some people! And he didn't even give us even a small donation much less the large donation he kept promising in front of his trekkers.
All we really wanted after that was a beer, but the obnoxious guide and the rest of the irritating Americans we in our usual tea house so we had a cup of tea instead. We were very disappointed in the attitude and actions of these American tourists and apologized multiple times for they way they had treated Arjun and our Nepali hosts. Some days, I wish we had Canadian passports.
H&C
March 28, 2013
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