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Education at 18,000 Feet: Altitude Sickness on Kilimanjaro

My first trip up Mt. Kilimanjaro was unusual. I was in the good hands of 20 African mountain guides, 60 porters, 14 paying clients and Eddie Frank, the owner of Tusker Trails. It was an easy hike for me because I relied on our guides to lead the way and keep us safe. The porters carried all of our gear. My time was spent watching the effects of altitude on the human body and designing a medical course that would teach the guides how to understand, prevent and treat Acute Mountain Sickness (AMS).

AMS can effect the body in a variety of modalities from nausea, vomiting and diarrhea to severe headache, acting drunk and/or having difficult breathing. On this particular trip I saw it all.

The altitude did not affect me, perhaps because I live at 9,500 feet in Colorado, however, the other clients on our trip live near sea level. Out of the 14 clients that started hiking at 6,500 feet in the hot steamy jungle, nine of them made it to the summit of 19,430 feet. Perhaps our high success rate was due to the fact that we climbed slowly over a period of ten days, allowing our bodies to adjust to altitude.

Most tourists ascending the mountain do it in four to five days, because the price of climbing the mountain is less expensive and they know little about the medical problems associated with AMS. Altitude sickness can happen so quickly that most people don�t know what hit them.

According to high altitude medicine expert Peter Hackett, MD, Mt. Kilimanjaro is the most dangerous mountain in the world for tourists to climb. The climb is fairly easy, but what gets people in trouble is ascending the summit to fast. By the time an untrained mountain guide recognizes their client�s medical problem, his health and safety are at risk. According to the local guides, approximately 10 to 15 hikers die on the mountain each year and many more are carried down on the stretchers because of altitude sickness. All of this could be avoided if the guides were medically trained and familiar with AMS symptoms.

Eddie Frank believed his guides could be medically trained and educated.

I first met Eddie Frank when he came to Crested Butte, CO, to attend one of my eight-day wilderness medical courses. Eddie, who has been guiding clients in Africa for 27 years, asked me if I would come and teach his mountain guides a course specifically designed for situations that may happen on Mt. Kilimanjaro. I gladly accepted.

Class was in the hot steamy jungle town of Moshi, Tanzania. African men are very shy and polite. When guides would reply to my questions in class, they would stand up from their chairs to speak. Getting the men to interact with me and ask questions was a big challenge. After two days into the course, I decided to entice them with money. If they asked a question or answered my question, I rewarded them. It worked. The guides started asking me questions like, why do clients act drunk at 16,000 feet? Why do others stop drinking and eating? Why do clients refuse to get out of their tents when I call on them? They started telling me stories about what they had seen on the mountain and what they did about it. They understood the information.

One of the guides I met was Hamisi. He is from the Chagga tribe and has climbed Mt. Kilimanjaro 100 times over the past 19 years. He started out as a porter, then became an assistant guide and then finally a lead. Hamisi has seen it all. He has carried people off the mountain and seen death. I knew I could learn from him and he could learn from me.

I asked him what he fears most about being a guide on Mt. Kilimanjaro. He replied his greatest fear is the cold. After the course he told me that he now understands how and why hypothermia can kill. He is excited to take this new knowledge back to his tribe. Thought the last time Hamisi attended school was in the sixth grade and English is his second language, he passed my class with flying colors.

I returned eight months later for the second course. I felt the guides were competent and confident in evaluating the health of their clients and making sound medical decisions on the ascent to Mt. Kilimanjaro. They also had the skills to approach any white woman on the climb, ask her how she is feeling and have the knowledge to take care of her.

This is the first step in what I hope will be the beginning of great medical training and education for all Mt. Kilimanjaro guides. They can now teach my lessons to their clients, porters and families.

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