Remote control in Nepal

During March and April 2008 I completed a six-week placement at the Machermo Rescue Post, in the Everest region of Nepal. The post provides basic medical care as well as education on altitude illness to porters, trekkers and locals.

Run by the International Porter Protection Group and located in the Machermo valley at an altitude of 4,470m – five to six days’ uphill walk from the nearest airstrip in Lukla and some two weeks from the nearest road in Jiri, the post is remote indeed. All supplies are brought in by porters and options for referral of patients were the local hospital in Khunde (one to two days’ walk away) or a helicopter evacuation to Kathmandu. The latter is only feasible for westerners with insurance.
 
The post was manned by myself and one doctor, although towards the end of my placement I was felt to have gained enough experience to man the post alone for three days. This was a brilliant experience and extremely confidence building.

Hypothermia risk

The post provides basic facilities. We had access to several oral antibiotics plus a few doses of IV Ceftriaxone. Other drugs were limited to basic pain relief and drugs used in the treatment of altitude related illness. Fluids were available but needed to be heated in a bowl of warm water to avoid compounding patients’ problems with hypothermia!

Our diagnostic machinery was an ECG machine and a single pulse oximeter. The thermometer had to be pre-warmed before it would function! We had an oxygen concentrator and a single bottle of oxygen to be reserved for the most seriously ill patients not coping without high-flow oxygen.

We also had a portable altitude chamber which enabled us to create an equivalent environment of approximately 2,800m - 1,700m lower than the post.

And that was pretty much it. Our clinic room was extremely cold so keeping the patients warm was an extra challenge.

Acute mountain sickness

During my time at the post, as well as taking turns to give a daily lecture on altitude illness, I examined and either treated, referred or evacuated some 40 patients. The bulk of cases related to mild to moderate AMS (acute mountain sickness) and gastroenteritis.

There were, however, some really interesting cases, including several of life-threatening altitude illness. There was also a child with massive hepatomegaly, a large volume haematemesis, cardiac chest pain with ECG changes, and a lady with severe pyelonephritis who had walked for two hours to see us. I also sutured a 10cm full-skin thickness laceration below the knee of a porter.
 
During my stay at Machermo I was able to learn much about altitude related illness. I also learned much about managing problems I was used to seeing at home in a much more challenging environment. I am extremely grateful for the financial support I gained by winning the MDU competition. Thanks very much!
 



This guidance was correct at publication 10/06/2009. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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