Back in Namche Bazaar

We started our last morning in Thame with a leisurely breakfast and then hiked up the northern ridge to a monastery overlooking the town. There is an old Stupa nearly the entryway to the monastery, as well as a very long Mani stone wall. We saw student monks, perhaps elementary school age, on the monastery grounds and also found a tea house up there. This would probably be a cool place to stay in the future. We returned to Thame for lunch to the sound of several monks chanting and praying in our tea house. They were using drums and other instruments, and we caught a glimpse of them on our way up to our room. They were wearing traditional red and orange robes, 10-15 of them, huddled in a room just below ours. They were still chanting and praying a couple of hours later when we left Thame to make way for Namche.

The path from Thame to Namche Bazaar is pleasant, rolling, and relatively short. Just outside of Thame we crossed the river on a steel suspension bridge, overlooking a narrow chute in the rock worn smooth by the rushing white water. Shortly thereafter we ran into an "introverted" trekker from the states. He joined us for a few miles and despite considering himself introverted, was quite chatty, and in fact was a biomedical engineer. He had studied at University of Washington and will matriculate in the graduate BME program at Columbia in the fall. Small world. He had taken a non-traditional career path having started a small company around a novel electrooptical diagnostic technology before heading back to school. Interesting dude.

The approach to Namche was quite beautiful...we had overwhelming views of the valley below us and became fully immersed in a tree-dense forest. We descended upon Namche from the Northwest and passed by the town's helipad and a field of newly-painted Mani stones. Upon returning to Namche, we found the Khumbu lodge - where we had agreed to meet Chris & Penny - set down our things (in another place occupied, at one time, by Jimmy Carter), and found the pizza joint and bakery for some snacks and a beer. We no sooner started digging into our lunch when Hillary heard Chris and Penny's voices passing by the patio. We flagged them down and made our plans for dinner at the Lodge. We spent some time shopping for gifts and souvenirs and reorienting ourselves with Namche before re-uniting with the Hills for dinner.

The reunion dinner was superb...we splurged on a couple bottles of red wine and partook in the Yak steaks that were available. Perhaps most striking, though, was the tomato salad. We ended up ordering 3 of these appetizers which were incredibly simple yet so welcome to the taste buds. Fresh fruit/veggies! The tomatoes were simply sliced, salted and doused with vinagarette. We proceeded to order several of these plates the following night as well. All around us in the Lodge dining room were Everest climbers recounting their experiences on the mountain and celebrating their summits.

Later that night we visited Namche's Irish Pub, complete with snooker and foosball tables. Sadly, they were out of Guinness, so the Chris's opted for a "local whiskey" that just could've substituted for airplane fuel. Somehow over the course of conversation we arrived at a proposal to compete as couples in a fancy dress (re: costumes) contest. The losers would be buying dinner and a round of drinks. Game on! The competition was tentatively scheduled for our arrival in Lukla in a few days. Given the previous days' treks and the 10pm curfew at the Lodge (they lock the front doors at that point) we retired relatively early and sleep found us quickly. Nevertheless, we were all awoken by the sounds of drunken climbers pounding on the front doors sometime after midnight. A healthy monsoon rain had set in so they were certainly anxious for shelter. Drunk and wet, they were rowdy for over an hour, keeping us up, until someone mercifully opened the doors for them.

View of Thame from the ridge leading to the Monastery:

River crossing just outside of Thame, with beautiful paintings on the water-worn walls of rock:

Another Jimmy Carter favorite...the Khumbu Lodge in Namche Bazaar:

Gokyo Ri

Despite the recommendations of other trekkers and our best intentions, we got up a bit late for our ascent of Gokyo Ri, a high point above Gokyo and the lake that offers tremendous views down-valley and also of Everest (on clear days). The recommendation was to get up and out such that we reach Gokyo Ri by 6 or 6:30am to get the best views...which means we'd have to start the hike by 5 at the latest. Well, given our long day the previous day, we slept in a bit and finished breakfast around 7:30. We decided to make an attempt on Gokyo Ri anyway, and leisurely hiked up the steep, dusty path over the course of about 2 hours. We were pleasantly surprised to find that the weather held out (i.e., the clouds rolled in later that day) and gave us stunning views of the glacial lakes, the glacier to the west, and the peaks to the north. We encountered beautiful, almost iridescent, blue birds on the way, as well as numerous people really struggling with the hike. Although there were lots of people up there when we arrived and some clouds had emerged, we were gratified by the hike and views. We descended easily to Gokyo to relax, take some lunch, and plan our trip over the Renjo La.

After lunch we were itching for some cleanliness. Wearing the same socks for day after day on these hikes had taken its toll on our feet and we decided to wash our feet in the lake. It was incredibly refreshing and soothing to clean up a bit, although the water certainly chilled to the bone. After washing, we lazed in the sun on a hillside taking in the view of the lake, Gokyo Ri, and examining the route up to Renjo La. We later retreated to the Lodge for more Yak steak and beers with the Hills.

Blue bird on the approach to Gokyo Ri:

Looking down-valley at the glacier and glacial lakes from Gokyo Ri:

 View looking west from Gokyo Ri...looking for Everest but the clouds prevented us.

Cleaning up in Gokyo Lake...

Cho La and Yak Burgers

Today we began the trek across Cho La. "La" is a Tibetan term for mountain pass. It proved to be a long day and challenging ascent and descent, but the experience of walking across two glaciers in a single day was absolutely incredible. We left Dzongla early in the morning after a breakfast of toast, baked beans, eggs, and coffee, and we headed further up the valley below Cho La. There were several other trekkers crossing the pass with us that day so the trail was somewhat busy. The first leg was along a green valley floor and although the sky was clouded, the weather was warm and pleasant. As we began to climb and scramble up towards Cho La we had to shed layers. A few hours later we arrived at the pass (elev: 5350m) to find that the clouds had cleared and we could see Ama Dablam, Taboche, and some of the other major peaks around the valley. The top of the pass also afforded us our last view of Pheriche. On top of the pass was the Cho La glacier: a vast ice flow several tens of meters deep. After taking some pictures and finishing off our supply of jerky, we traversed the glacier (literally walking on top of the ice) until the Gokyo valley opened up beneath us. The descent into this valley was hairy just below the pass - at several points we just slid on our butts to get down because the path was either loose scree or icy/wet stone and über-steep. Eventually we made it down and found steady sun in our "new" valley.

We spent a couple of hours on rolling trails and moraines to our planned lunch spot, a village called Dragnag. Crossing the Cho La took a lot out of us, and we lingered at the first teahouse we found for hearty pasta lunches and a large pot of milk tea. Despite our inertia, we pushed on towards Gokyo, our planned stopping point for the next couple of nights. The weather had turned grey again and the path to Gokyo led us across yet another glacier. Rather than a snowy surface, however, this broad ice flow was covered with grey stone. Only below the surface, and in a few small lakes, was the ice to be found. The combination of the grey sky and the grey earth gave the impression of walking on the moon or another planet. It was an eery environment to be sure, as throughout our passage across the glacier we also heard the sound of ice and rock falling into pools and lakes...the glacier is very much "alive" in that it is continually moving and changing shape. The time scale over which this happens is shorter than you would think though!

Rain started to fall as we approached Gokyo and the daylight began to dwindle. It was a great relief to arrive at our lodge (Namaste Lodge; recommended by the teahouse owner in Dragnag). The dining room was warm with a yak dung fire and busy with the chatter of several groups of trekkers. The owners even greeted us with "welcome juice" (hot mango). Chris and Chris spotted yak burgers on someone else's plate across the dining room and decided to order the same for themselves. They were not disappointed! After finally reaching our destination and fueling up we retired early, looking forward to the next day of relaxation and exploration.

Last view of Pheriche, from Cho La. The clouds only got worse the longer we stayed.

 Crossing the Cho La glacier. Those specs in the middle of the snow field are people.

Striking a pose midway across the glacier. Pic taken by a Sherpa guide who had brought a patient to the clinic earlier in the season.

 Crossing the Khumbu glacier...had a "lunar" feel to it.

 Gokyo and Gokyo lake...our destination for the next two nights. A sight for sore legs...

Closing Time

Today is the closing of the HRA Aid-Post. We finalized all of the inventories, counted the final bank, and covered the equipment with plastic and sheets. We closed up and locked the pharmacy closet after placing the TV, DVD player, ultrasound, EKG machine, oxygen tanks, and oxygen concentrators inside. After lunch we took down the signs and put up a closed sign with phone numbers to the nearest medical facilities in Namche and Khunde, both nearly a day's walk away. After no one showed up for the final lecture, we brought in the cushions and chairs from the sunroom, then closed and locked the door. In an effort to leave the clinic in a better state than we found it, we picked up the common areas, shook all the mattresses, and swept the floors.

This morning we tried out Pembadiki's porter basket for carrying yak dung, then she invited us in for tea made on a stove built by her father, Ang Rita who worked for the HRA for many years. Her home is a single room, simple but cozy. She has vegetables and onion growing in the windowsill and a butter churner in the corner. She is the exception to the rule that everyone descends for the summer. She will follow her yaks up to the Kongma La in search of green grass for several weeks before returning to visit her family in Pangboche.

Dr. Luanne Freer, who was key in starting the Everest ER Base Camp Tent, arrived this afternoon in Pheriche with her team bound for base camp. Already several climbing teams have summited, slightly earlier than usual this year. There have been several injuries and a few fatalities, but it sounds like some great rescues as well. (By the way, no sign of Tom Cruise.)

Chris Hill and Penny left a day early to see the Italian Pyramid after finally contacting hem on Skype. They will meet us in Zhongla tomorrow where we will stay the night. Arjun was planning to go over the mountain passes with us, but he was informed of some last minute training in Kathmandu on May 24. He and Jeet will leave at 6am tomorrow with the goal of making it to Lukla tomorrow before dark. Jeet will continue to his hometown another few days walk. Arjun will fly back to Kathmandu.

The four of us will spend the next week taking the scenic route down. We will spend the night in Zhongla before getting up early Tuesday to cross Cho La into the Gokyo valley. We hope to make it to Gokyo that night, then go up Gokyo Ri the next morning if the weather behaves for some good views. Then we will cross Renjo La and begin our descent to Thame, which was a part of the Tibetan trading route in the past. Finally, we will come back below the tree line into Namche Baazar on Saturday and Lukla on Sunday with the goal to fly back to Kathmandu next Monday. We will be offline for several days, so we will catch up on our stories on the flip side!

This is the Spring 2013 Pheriche HRA team... Signing off.

Altitude Illness Lectures

Every day at 3pm we give a lecture on altitude illness and prevention. These lectures discuss how the lower atmospheric pressure causes air to expand and resulting hypoxia (low oxygen in the blood). We highlight acute physiological changes at altitude including tachypnea (fast breathing), tachycardia (fast heart rate), and increased urination. Over longer weeks to months the. Body also increases red blood cells, metabolism, and some structural changes particularly in muscles. We also discuss the main types of altitude illness ranging from the benign high altitude headache and acute mountain sickness to the emergency conditions of High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). We also discuss warning signs as well as treatment (mainly descent although we do use some stabilizing and temporizing measures). These lectures are usually well-received and we get many good questions. Sometimes we demonstrate the Gamov Bag (a oblong bag which we can pressurize with a foot pump to simulate descent.)

March 20 (delayed upload)

Photo 1: Hillary gives the lecture in Pheriche while Chris holds the lecture cards.

Photo 2: Chris gives the lecture in Dingboche. During the busiest part of the season, we gave lectures on Monday, Wednesday, and Fridays also at 3pm at the Alpine Conservation Center.

Final Days and Unrelenting Haze

The final days in Pheriche are upon us. We are have already begun packing, cleaning, organizing, and making our final preparations for our trek out over the passes. Chris and I had planned to spend our last couple of days on top of the Kongma La and enjoying the outdoors, but a storm moved in from Bangladesh and brought a thick cloud that got stuck in the valley obscuring everything. Of our three day window, we had no reasonable days in which to attempt this pass, and so we spent the days going somewhat stir-crazy in the clinic.

We have all come down with Pheriche Lassitude. There have only been a few patients to occupy our time and even fewer in the lectures. Chris got so bored he gave a second lecture to only three people. Penny finished the medication inventory and took a three-hour nap. In between games of Solitaire, Hillary re-folded all the t-shirts, scarves, and hats, then blew up the Gamow bag for fun. Chris Hill researched homebrewing equipment inspired by our brew planning and searched for jobs in Canada. Arjun spent hours on Facebook and attempting to Skype. Pumo (the clinic dog) found a girlfriend and the other dogs have all been curled up in balls in our front yard all day. The yaks are all covered in frost. Even Utom (the main employee in the Himalayan Hotel) came by several times to chat and hang out. We watched old Will Smith and Tom Cruise movies. We considered starting the 3000 piece puzzle. While we don't wish ill health on anyone, we desperately wished for something to happen. We have rarely been so bored.

Photos: From inside the Gamow Bag.

Everest Memorial

Outside of the aid-post is a memorial constructed of rock and stainless steel for the climbers and Sherpas that have lost their lives on Mt. Everest (aka Safamartha, or Mother of the Universe, in Nepali). There have been at least 3 Sherpas and 1 Russian climber who have died on Everest this year, and a Japanese trekker perished on the Kongma La early in the season as well. The monument always draws a lot of attention for visitors to Pheriche. The polished stainless is meant to reflect the beauty of the surrounding mountains (rather than compete with it) and the names of the fallen are placed on the opposing faces in the gap between the peaks such that you must insert your body to read them...it's meant to make for a more intimate experience. It's quite the landmark and a powerful symbol of both the risks taken and the ambition of those who brave Everest.

An unsubstantiated rumor

Tom Cruise will be passing through Pheriche on his way to Everest Base Camp in a few days, accompanied by an HRA veteran. Last night we watched Top Gun in his honor and also because we are running low on new movies.

Note: This rumor has been circulating for years. Stay tuned.

Pea soup

So much for crossing the Kongma La. We awoke to exceptionally foggy conditions that persisted throughout the day. Even if we made it up to the pass, it is likely that we would've seen nothing but fog and clouds. It is eerie and strange to basically be within a cloud for two days.

Some porters passing by the mani stones in Pheriche gradually emerge from the fog. Visibility was limited to maybe 15m.

Yarsagumba

Traditional Tibetan medicine often involves herbs and medicinal plants. However, there is a special type of fungus which is a caterpillar parasite which is worth it's weight in gold - literally. Known as yarsagumba and described as half-animal, half-plant, this is a truly unique organism and not well-understood. The fungus "sprouts" from the ass end of the caterpillar during a late stage of larvae development and grows up to 15cm. In the process, the caterpillar is mummified and kind of forms a root for the fungus. Pretty nasty looking. Anyway, 1 kg (2.2lbs) of these things is worth ~300k rupies ($3500)...and since these grow well here in the Himalayas the locals spend quite a bit of time seeking them out. The claimed medicinal effects range from anti-depressive to aphrodisiac to generally protective of bone marrow (in irradiated mice anyway). Fascinating...

We bring this up because our counterparts at the Manang clinic have encountered many cases of snowblindness in locals harvesting yarsagumba near the snowline in the Annapurna region. Apparently it's that time of year.

Snapshot of a website describing the yarsagumba. These things don't grow near us in the Everest region.

The Kongma La

Today we planned to cross the Kongma La which is a high mountain pass between the Imja and Khumbu valleys. The Kongma La is a challenging single-day trek or a relaxed but potentially chilly overnight. High on the ridge near a chain of lakes is an area which is frequently camped with stunning morning views. We found a tent in the back of the Aid Post and borrowed sleeping pads from Chris and Penny. We also got some bread, cheese, boiled eggs, and chapati from Jeet to supplement our dwindling food from home (mainly trail mixes of nuts, seeds, and dried fruit).

When we were at base camp last week, teams were looking at weather reports for May and had identified today and tomorrow as ideal summit days, and as recently as yesterday had heard from up the valley that Karina and Scott's team was still pushing to summit tomorrow (May 17). It seemed like a good Kongma La window as well. This morning there were low clouds which is unusual for the mornings here in Pheriche which are usually clear with low winds making morning hiking ideal. We were hopeful that the clouds would burn off and reveal blue skies. We packed our bags and headed out shortly after breakfast this morning, but just as we left, it began to rain.

By the time we reached the top of Dingboche Ridge, we could no longer see more than 20 feet in front of us, and we were getting wetter by the minute. We probably should have admitted defeat and turned around for the relative safety of the Aid Post. However, stubbornly we pressed on. After descending to Dingboche, we still could not even see the end of town much less the pass we were aiming to climb.

We decided to stop for some tea and see if it cleared by 10:30-11 or so figuring we could still make it to the campsite by dark. However, it really needed to stop raining for this plan to work as we had brilliantly left the rainfly to the tent back in the clinic as it had yet to rain here as of yesterday. Even if it had snowed, the snow here is so dry it is basically little pellets that bounce and we figured it would not soak the tent. Just our luck. In the meantime, we decided this would be an ideal place to write our wedding vows which we have been meaning to do since we arrived and had not yet finalized.

We finished up around 11am and dark clouds still covered the area over the Kongma La, so we decided to retreat to Pheriche. Chris and Penny had finalized their house buying and we have only a few more days so we bought a few beers and headed back over. In addition, we got a couple of additional Nalgene bottles for the seabuckthorn juice to travel back home.

Just as we crested the ridge again, the sun broke through in patches. We decided to stop for a picnic lunch and beer on a rock and soak up what little sun came through. We finally descended back to Pheriche and were somewhat satiated by the continued black cloud over the pass. Chris, Penny, Arjun, and Jeet greeted us on our return with good news! With the poor weather and low clouds, helicopters had not been able to fly above Pheriche for several hours. Arjun had offered a stranded pilot some tea and arranged for the backpack with the computers, money, and blood tubes to go back to Kathmandu. Success!

In completely unrelated news, the tea houses are nearly empty and some have even closed for the season. We had zero patients today and so we feel more justified in closing and leaving. However, there is a group of gray-haired, overweight Americans which are in the Himalayan Hotel tonight which just came back from the HRA Aid Post with a whole stack of our t-shirts including several from the "Half price - Fell off a Yak" stack (a bit muddy and al XXL). Another success!

Ironwill inspiration

We have been informed that the Ironwill taps are running dangerously low back at home, so we have been planning an upgrade to some brew equipment and to brew some Himalayan inspired beers. In fact, we recently placed an order for the new equipment (new kettle, pump, carboys, etc.) and enough grains, hops, and yeast for 30 gallons of beer to be brewed immediately upon our return. The plan is to start with a batch of cherry wheat since it should be ready within 2-3 weeks. Next we'll brew a "Khumbu kolsch" brewed with glacier hops...this will be a relatively light and crisp beer perfect for hot July days. Finally we'll brew up our two-hearted ale (an all-centennial IPA) clone. Once these beers are on tap, we'll start up our Himalayan Pale Ale (HPA), brewed with summit and glacier hops...and an experimental version supplemented with Seabuckthorn juice. Seabuckthorn is a shrub that grows well in the Khumbu and has many practical uses. The yellow berries are removed and crushed to make juice, which is often served hot. Although a bit astringent, the aroma and flavor of the juice is quite mild and rather summery. A local woman made some juice fresh for us yesterday, and we will attempt to add some to our HPA to provide a little fruitiness. We're hoping it will turn out along the lines of magic hat's #9. Finally, we will make use of some Neplese tea (more commonly drank than water or coffee here) in a beer or two brewed later in the summer. We have visions of a Milk tea stout and possibly an English bitter spiced with the tea. In both cases we're hoping to nitrogen ate the beer for a truly unique combination of flavor and mouthfeel. Can you tell we're itching for some real beer? ;)

The Ascent of Rum Doodle

There is a classic novel which is a spoof on mountaineering called The Ascent of Rum Doodle. The short novel tells the tale of an ill-fated mission to climb a 40,000 foot peak called Rum Doodle with a navigator who is always lost, a medic who is always ill, a medical kit consisting of only champagne, and a very poor cook named Pong.

Since arriving we all took turns reading this classic and quoting it. We have also taken to calling any mountain of which we do not know the name or any day-hike which turns epic "the Rum Doodle". There is reportably a bar in Kathmandu named Rum Doodle which we intend to find on our return to Kathmandu.

There is a large hill across the river in Pheriche which we stare at all day which is part of the ascent to Taboche which has been nicknamed "HRA Hill" because every HRA volunteer attempts to summit it at some point during their stay. We are no exception. Unfortunately, it is quite steep and has only a rough trail which leads to yak trails, rocks, and basically misery. We made two attempts at this "Rum Doodle" ascent. In the first attempt, we had issues crossing the river and walked so far upstream that we nearly made it to Dughla. The second attempt was plagued with high winds, snow patches, an a disgruntled yak. We made it as far as the false summit (aka the North Doodle) before abandoning the mission and retreating for an Everest, the champagne of Nepali beers.

The Final Week and the Big Helicopter Transport Challenge

The final week of our time in the aid post has arrived. We will be closing the clinic and leaving Pheriche on Monday, May 20th and heading back to Kathmandu. As we prepare to close up the clinic, we have several tasks. First is to update the medicine and supply inventories, finalize patient records, and count and organize the money made over the season. We have started several electronic documents such as excel spreadsheets of the medicine inventory, the patient visits and diagnoses, the lecture attendance, and financial records. In addition, each of us has to write a report on our time here with comments on the experience and suggestions for improvement.

Chris has been the Excel-master making graphs and statistics which I doubt anyone considered calculating before. He has lecture attendance based on location and date, patient diagnoses, and a host of other graphs to insert into his report.

The HRA is a non-profit, non-government organization which barely operates in the black each year. Any "extra" money on good years goes back into the clinic to make repairs, update the power system, and get additional equipment or supplies. The season we have been down by at least 20-30% of patient visits, so we are likely down in income as well.

Once the money is counted, the books have to be balanced and then the money has to be transported to the Kathmandu office. This is a challenge. The money needs to take the most direct route to Kathmandu possible with a reliable and trustworthy person. Arjun has previously taken the money down by himself through Namche and Lukla. The money has also sometimes traveled by helicopter. The problem comes in that we want to trek out by the scenic route over Cho La and Renjo La, two more mountain passes which are beautiful but require 6-7 days verses two days (see map in previous post for the route.) Arjun has never been that route and would like to go with us, but we cannot bring the money with us. While it is likely nothing would happen since it has been many years since Maoists bothered trekkers in this area, it has happened and besides, it's actually a lot of added weight to carry on our backs.

In addition to the money, we have three laptop computers and the research blood samples which would benefit from expedited helicopter transport back to Kathmandu rather than the week of traveling with us or the shorter 55 km trip by yak or porter. Yet, we still must determine that the helicopter pilot is trustworthy and that it would make it to the HRA safely. Several other items we have tried to send down by helicopter with less worth have been lost along the way. The main source of concern is that the helicopters often stop in Lukla and people and cargo must often change helicopters or planes to continue to Kathmandu. We have been trying to find a direct helicopter flight to Kathmandu with a good pilot for about a week without success.

Yesterday some of the researchers from the Italian Pyramid stopped by on their trek up to the pyramid near Lobuche (see previous post for picture and description). One of the lead investigators, Peter, offered to try to help us with this task as he knows a few pilots coming up soon. One of these is a film crew for a movie featuring Reinhold Messner (arguably the world's greatest mountaineer who has summited all 14 of the worlds 8000+ meter peaks and many of them solo.)

With the possibility of this lead, we sorted and counted all the currencies and triple checked the books. We also packaged the money, the computers, and the blood samples into a small backpack to be ready at a moments notice which is often all we have for helicopters.

Today the film crew came with Reinhold Messner. Chris Hill was actually able to meet him during the filming, but we were busy with patients. Unfortunately, the helicopter was taking a longer route back than we had anticipated and was also stopping in Lukla, so our bag could not travel with them. In the meantime, Chris sewed a HRA patch onto the bag which took him about an hour.

Maybe we will find a helicopter tomorrow. We have about a week to figure out this logistical challenge.

To be continued...

Mustang coffee

Rocksi is the local fire-water made from a rice base which is somewhat like saki but with a smoky flavor. Rocksi is made in the region although not in Pheriche but is available if you know who to ask. Chang is another type of Nepali adult beverage which is more beer-like but harder to acquire in the Khumbu. After hearing about it, Chris Hill decided we needed to sample rocksi, and he and Jeet went on a mission. Upon return, Jeet got very busy in the kitchen making a speciality drink called Mustang coffee which involves burnt sugar, butter, salt, rocksi, and instant coffee. We had heard rumors of this beverage from the Machermo group and were a bit apprehensive. Indeed, this turned out to be one of the most vile tasting liquids to pass our lips. And given enough time, the butter separates out and forms an oily sheen on the surface rendering it even less appetizing. Fortunately placing the cup on the stove for a bit helped re-emulsify the butter, but with each re-heating the taste became worse and worse. While I can't imagine it becoming a personal favorite, we all agree it tests better than it smells.

Calling Bangladesh...

We have had several challenges in communications since our arrival. Some areas of the Khumbu region have 3G connectivity or at least some cell phone service, but Pheriche is in a valley and completely void of cell service. The Internet is satellite-based and while fine for email, Skype and similar programs are unreliable during busy times.

There is a VHF phone which connects through Khunde which is weather-dependent but is currently our most reliable phone. However the battery is old and doesn't hold charge. It has about a thirty minute battery life before it has to be recharged. The battery must be removed to be recharged and since we only have one battery, when it is charging, we cannot be contacted. A satellite phone arrived by helicopter a few weeks after we arrived, but so far we have only been able to call China and Bangladesh. Likely operator error, but yet to be resolved.

Then suddenly one day last week while preparing for a phone interview for Penny for a fellowship in Canada, the charger to the VHF phone blew up. For days the phone was out of commission until another charger could be located which is not the correct one, but seems to do the job. Supposedly a replacement charger is being sent up on a helicopter, but we have yet to receive it. Unfortunately, the phone circuits are all scheduled to be shut down for the summer for maintenance on around May 15.

Against all odds and these technological challenges, Chris and Penny have managed to change their airplane flights, interview for jobs/fellowships, rent an apartment, and buy a house! We had difficulties trying to send flowers for Mothers Day.

Photo 1: Chris Hill calls Bangladesh instead of Kathmandu while Pumo (the clinic puppy) watches.

"It's an experience, not a holiday."

-Suzi, from the Everest ER, on spending time in the Khumbu, to her fiancée.

Everest ER Base Camp Tent

From Gorak Shep, we hiked to the Everest Base Camp. Base Camp is actually not a particularly good campsite seeing as it is on a glacier covered with rock debris which is quite uneven and cracks and creeks at random. It also has ice pinnacles and underground springs from the melt as well as random pools within the glacier. In addition, you can't even see Mt. Everest from base camp.

The HRA also has a tent at Everest Base Camp (aka Everest ER) which we went to visit and spend the night. Three of our colleagues are stationed here, Suzi, Kirsty, and Pranav. In order to work at the EBC tent, you have to already have volunteered at either the Pheriche or Manang clinics for a season. The clinic tent was well-stocked for a tent and warmer than our clinic room.

They also have a mess tent which was well stocked with snacks and warm drinks. The Everest ER crew is supported by a commercial group which also supported a group of climbers, so they had a cooking tent and staff of at least four as well as more "exotic" foods than we had seen in weeks. When we arrived, they had just brought out a plateful of fresh watermelon.

We arrived in time for lunch which included freshly baked croissants, tuna, and potato salad which contained pieces of fresh apple. Amazing. After lunch, we wandered around base camp until it started to snow, when we retreated to the mess tent and spent more time hanging out with the crew. The commercial group supporting the HRA is also supporting the summit attempt of a Brazilian doctor and TV personality named Karina. She will be videoed and photographed by Scott, the shooter that interviewed Hillary and Chris earlier in the season. Karina and Scott were in the tent with us, discussing the possibility of a "weather window" in the upcoming days. Basically climbers in the base camp hang out for weeks on end for such a window: a break in the winds that is long enough for them to go from base camp to camps I, II, III, and finally to the summit and back. Last year, there was a single, 2 day weather window and there are photos of climbers literally waiting in line to make their summit attempt because there were so many of them. Scott was conferring with other groups and acquiring weather predictions from a variety of sources to verify the likelihood of the window. It was an exciting time to be at EBC!

Later we met for a dinner of dahl bhat...but dahl bhat unlike any other on us trip. It was served with a curried hard boiled egg (delicious) and a dollop of fresh salsa. Then, fruit for dessert! After dinner we enjoyed a hot tottie (whiskey + hot water + honey) courtesy of Lakpa and then went to see a movie at a large tent near the clinic tent. We had been invited by another expedition group to join them for the movie, and this was the real deal. They served wine and popcorn, and projected the movie on the back of the tent such that it was about 15 ft diagonal in size. Might as well have been at a movie theater!

After the movie we retired to a tent set up for us by the expedition company. Despite being located on a rather mobile and unstable pile of hard glacial rock, we slept soundly. Only the occasional shift in underlying rock or ice woke us up.

In the morning we enjoyed a breakfast of fried egg over spicy potato and some coco puffs on the side. We then packed up our stuff and started our descent back to Pheriche. We were sad to go! Such an incredible experience!

HRA's EverestER tent and 2013 Team: Kirstie (in blue), Suzi, and Pranav. Scott is at left getting advice on de-worming.

View of the Khumbu Icefall from Everest Base Camp. This is one of the most treacherous parts of the ascent as it involves traversing very unstable rock and ice as well as crevasses with ladders and ropes. Teams of Sherpas scout the route each year.

Ice pinnacles within the glacier. These were all over the place in base camp. So much ice and rock comingled and simultanesouly highly ordered and disheveled. The icefall looks remarkbly like a river or even the ocean with rises in falls in the ice that resemble waves. In many ways it is just a river that moves much more slowly than liquid rivers.

Happy Nepali Mothers Day!

Happy Nepali Mothers Day to all the mothers out there. (Nepal celebrates a few days early.)

The Italian Pyramid and Gorak Shep

We left Lobuche en route to Gorak Shep by way of the Italian Pyramid. The Italian pyramid is a landmark on the Everest base camp trek and has been around for over 20 years. We decided last-minute to check it out, and we were glad we did. We approached the pyramid around 7:30a and found the Nepali staff enjoying their morning tea and biscuits. We chatted and took tea with Kagi, the Nepali manager there for a while, basking in the sun outside the pyramid. The pyramid is composed of steel and glass, mostly, with numerous solar panels covering the south and west faces. It houses laboratory space, a modest medical suite, radio room, and office space. Quite remarkably, the entire pyramid and attached lodge can be operated remotely from Italy via a satellite Internet connection. Nepalis and Italians collaborate to staff and run the pyramid, and the focus of their efforts is monitoring the weather and geological changes in the Khumbu region. There is a piece of instrumentation called "Doris" that measures changes in the absolute position of the ground, and there are numerous weather instruments in the region that are connected wirelessly to data acquisition systems at the pyramid. Interestingly, the chinese forced the nepalis to remove seismic sensors from the grounds of the pyramid...presumably because of the close proximity to the Nepal/chinese border. The facility also has an impressive solar array beyond what is attached to the pyramid. Supposedly the rooms in the lodge for the staff are heated. Crazy!

Kagi advised us to take a "high trail" behind the pyramid back to the main trekking route towards Gorak Shep, the next stop on our way to Everest base camp. Though a bit slower going than the main route, we had incredible views of the glacier from our elevated trail. The trail to Gorak Shep then turns into a rough morrain with a rolling up and down approach- you really feel like your in glacier territory here. It was a tough stretch but the weather was ideal and we were in no rush so it was a pleasant trek. We arrived at Gorak Shep in early afternoon, ordered a bunch of pasta for a late lunch, and then wandered along the trail to EBC for a while before returning to the Himalayan hotel for dinner. We reconnected with Mike too (he had shot ahead for lunch at EBC) and killed a few hours playing No Peak and eating dinner. We marveled at the availability of 3G cell coverage here - our first since leaving the states! We retired early because we planned to wake up around 4am to ascend Kala Patthar ("black rock" in Nepali/Hindi), a high point in Gorak Shep that provides views of Mt. Everest which are particularly beautiful at dawn and dusk.

Waking that early was somewhat painful, but since we went to bed at 8pm it could've been worse...and in any case it was worth it! We started our ascent in the dark of course, but even halfway up to the 5550m peak (our highest point of the trip) we were capturing exceptional views of the Khumbu valley as dawn broke. Ama Dablam was one of the first peaks to be hit with light and Loboche peak was hit early too. Mike was burning up the hill and beat us to KP by about 30min. Nevertheless, we made it in time to see the sun shine first from behind Everest and then from over Everest. Breathtaking. Some of the best views were of Pumori, the mountain opposite Everest on the other side of the valley and just above KP. Randomly, we arrived at KP just as a Chinese trekker arrived, breathless and carrying an iPad. He intended to take a picture of the iPad, which had a picture of his friends, next to a Chinese inscription on the rock. But his camera battery was dead (probably from the cold) and so he asked us to take the picture for him. We obliged and he was so grateful he managed to insert himself into several of our photos up there!

We had the top of KP to ourselves for perhaps 20min before numerous other trekkers arrived. There is not much space up there so we decided to descend and get some breakfast. We hadn't realized how hungry we had gotten in ascending KP - upon finishing our breakfasts of egg sandwiches, we all immediately ordered second breakfasts of an additional sandwich! After recovering a bit, Hill and I packed our things and made for EBC, while a mike headed in the other direction towards the Cho La pass on his way back to Machermo.

Italian Research Pyramid:

First light hitting Ama Dablam, from near Kala Patthar.

View of dawn breaking over Mt. Everest (dark peak near the center of the pic) from Kala Patthar. ~5a

Ascent to Loboche

Today we left the clinic on a multi-day trek to Everest Base Camp. The first step of this was to ascend to Loboche which is at 4900 meters. To get there from Pheriche, you can either go up the valley to Dughla and then cross over the moraine to Lobuche or you can go around through Dingboche and over the Kongma La. The Kongma La is a challenging mountain pass which is where the Aussie and Mexican got lost weeks ago and where Chris and Penny made an epic one-day round trip (see past posts). One of the other doctors from the Machermo clinic, Mike, came to Pheriche last night and tried to talk us into going over the Kongma La, but we decided to make that a separate trip. We stopped above Dughla at a plateau where numerous chortens and prayer flags were placed as a memorial to lost/fallen Sherpa. We had incredible views of Taboche, Ama Dablam, and yak trains loaded with gear coming down from Everest base camp.

In the end, Mike would have been much faster than us as he did the pass in only six hours and was waiting for us when we arrived. However, we all stayed in the same lodge and played cards (new game: No Peak) after dinner. Then one of the locals began playing a wooden flute-like instrument and some women began singing Nepali folk songs. It was a wonderful impromptu concert.

At the Sherpa Memorial between Dughla and Loboche:

Yak Train, also near the Memorial:

Alpine Spring

Spring is emerging up here in the Khumbu and Imja valleys. We have taken a few day hikes to explore signs of green and growth. In both Dingboche and Pheriche the locals have planted fields with potatoes. In Dingboche the fields are watered via crude aquaducts (which run through the center of the village) and channels that are cut ad-hoc into the fields. The farmers then use large platters and manually "sprinkle" the fields from these channels.

The only flowers we have encountered are tiny purple ones that stem from aloe-looking leaves...just 5-10% of the size of aloe.  They are concentrated near springs and river banks, but often show up in the middle of trekking trails too. Remarkable. They are so small and unlikely to survive among the hugeness and harshness of the weather here, yet almost smile up you from the trailbed.

Juniper and cardamom (we think...) are the other plants that thrive up here and are in abundance. The cardamom has not woke up yet, but there are vast fields of dried green and red cardamom from last year throughout the region. We've found that the juniper overtakes north-facing aspects of the hills and mountains, whereas cardamom is restricted to more southerly faces.

Juniper (green, foreground) on the banks of a stream near Bibre in the Imja valley. Dried cardamom is in the background (kinda brown).

 Some of those tiny, ambitious purple flowers also in the Imja valley. Just outside a small settlement that abuts a stream.

 Main street Dingboche, with aquaduct. The pipes run to nearby teahouses for general water supply. At various points along the aquaduct farmers cut channels into fields for feeding their potato crops. Supposedly barley can also be grown up here, but we've haven't seen it yet.

 

 

Brawls, Belated returns, and Bloodletting

Normally we have a loud bell which people can ring at any time of the day or night for emergencies. However, last night we got a knock on the our window at 2 am which nearly scared us to death. We thought a yak was trying to break in or something. A guide had brought down a young man from Oklahoma on a stretcher with oxygen.

Ironically, we recognized him from the bakery in Dingboche from two days ago who was talking about his group's "aggressive" ascent schedule. He had gone too fast for his acclimatization and had succumbed to HAPE and HACE. Unfortunately for him, his guide had not recognized AMS symptoms in him in the several days beforehand, and although he had been warned not to ascend with symptoms, he did anyway. Also unfortunately, his guide has a drinking problem. Luckily for him, his guide and put him on oxygen and found a team to carry him down almost 1000 meters despite being intoxicated. He was actually doing quite well by the time he reached us although we continued him on oxygen overnight. The guide promised he had already arranged helicopter evacuation for the morning.

However, when morning arrived, the guide returned still reeking of alcohol and got into a shouting match with Arjun which nearly turned into punches. Much of the town of Pheriche turned up to watch. From what we understand, it was mostly about money. All the guys tried to intervene in the argument to avoid any injuries. In the end, the patient finally got a helicopter, the guide took off likely for more rocksi (the local rice-based fire water - kinda saki-like), and Arjun called the main office to report him and found out he is related to a famous politician. And this was all before 7am.

Chris & Penny had planned to hike to Kongma La (the same challenging pass which the Aussie and the Mexican had gotten lost on) in a single day. We had been told by multiple prior volunteers that it was possible in good weather. However, because of the altercation, they got a later start than planned.

The morning was busy with several patients and multiple tour groups including a WMS group with a BWH colleague, but we got some good donations and many t-shirt sales. The afternoon weather turned sour and even began snowing at one point, and we wondered how Chris and Penny were doing on the pass. Rachel and Nick who are volunteers in the Machermo aid post (a different but "friend" organization over Cho La near Gokyo) also came to Pheriche. (By the way, "La" means mountain pass in Nepali.) In addition, Sarah and Jim from Extreme Everest and Suzi from the Everest ER base camp tent also turned up. It was a little reunion. We had Rachel, Nick, Sarah, and Jim all over for a beer after a dinner of samosas. (Since Jeet learned they were a favorite, we have had them more often.)

Chris and Penny had still not arrived by dark. They had a sleeping bag and had borrowed our bivy sacs, so they would probably survive a night out although it would be uncomfortable. However, we were just discussing sending a search party when they turned up exhausted and starving. The gathering in the clinic was tame but enjoyable and after Chris and Penny arrived back safely, we had more to celebrate.

Always the researchers, we had asked everyone who had been at altitude for several weeks to donate a small amount of blood for the research study. Since most everyone present was medically trained, we had them draw each other's blood which resulted in the guys getting lightheaded and having to lie down. But in the end, no harm done, and we all went to bed around 10pm as it had been a long night for everyone.

02 May 2013

Challenges in research and the defective DNA tubes

We have a research project which is ongoing up here. There are two parts to the study. One is similar to the prior study I did in 2008 with ibuprofen as an alternative treatment for high altitude headache. This time we are also comparing it to another medication. The second part of the study involves DNA sequencing of people who do and don't have symptoms of altitude illness. Both of these have had some challenges.

First, the clinical trial (headache treatment part of the study) requires that our subjects have a headache at that moment which they are enrolled and that they are willing to track their headache for the next two hours. Initially, we had planned to keep the subjects in the clinic, but cold temperatures and space made this difficult. Also, we are having trouble recruiting subjects. Patients who come to the clinic have often already taken a variety of medications for their headache which makes interpretation difficult. We tried recruiting from the tea houses at dinner, breakfast, and even mid-afternoon with limited results. This technique had worked for the previous study I was involved in, but was not very productive this time.

Second the DNA blood collection has been difficult. First, many people do not want to give up their blood. Although we are not taking much, they prefer to retain all the red blood cells they can for transporting oxygen. I admit that I do understand their concern, but the blood is a very small amount and shouldn't matter in their performance. Second, the blood is difficult to collect. The clinic is near freezing most of the day which makes veins constrict and drawing blood a challenge. In addition, the DNA collection tubes are malfunctioning. These blood tubes are very special in that they do not have to be kept at a certain temperature and the DNA is still good. They are fairly new and although skeptical, it will be awesome if they work. I had called the company before leaving Boston to ask if their tubes would still function after flying around the globe on four flights, being transported to 14,000 feet on a yak, multiple freeze-thaw cycles over several months, and then the whole thing in reverse. The company assured me this would not affect the DNA stability and that they would still function at altitude. They were wrong. In order to collect blood, most blood tubes have a vacuum inside which helps them fill even though they are sealed. Initially, we tried several methods of venipuncture thinking the butterfly needles were the problem with the convicted veins which resulted in Chris and Penny getting covered in blood during one collection gone awry. However, it finally dawned on us that with the much lower atmospheric pressure here, the tubes did not have enough of a lower pressure to create a decent vacuum. By drawing 20mL of air out of the tubes before using, they then worked. Hopefully, this does not alter anything significantly upon descent or cause the tubes to break when repressurized.

There are also two things which are also out of our hands that have decreased our potential subjects. First, there are fewer people trekking in part from fewer flights from Lukla due to colder, snowy weather and new weight and passenger restrictions on flights. Second, the large Extreme Everest group is doing their own research and so none of their subjects are allowed to participate. They are taking up over half of the biggest tea house for over eight weeks and so many other trekkers are staying in Dingboche instead.

These challenges aside, we are hoping for more research subjects so that we do not have to continue the study next season.