Kili in the early morning

The summit certificate is lying at home, so I could actually tick off Kilimanjaro. But Africa’s highest mountain is still on my mind half a week after my return home. My feelings were too ambiguous during the eight days on the highest mountain in Africa. On the one hand I was able to experience hospitable and helpful Tanzanians, a harmonious expedition team and a really impressive nature. The ascent through the various vegetation levels gave me many unforgettable moments. On the other hand, I realized once more the downsides of mass tourism on the mountains.

Human waste along the way

Caravan to Kibo Hut

Even though about 30,000 people try to climb Mount Kilimanjaro every year, there is neither a coherent plan for hygiene nor for waste disposal. For example, at the Kibo Hut, at 4700 meters, there are some simple toilets, but there is no water to wash your hands. The few toilet shacks along the Marangu route are little more than spoilage. Behind almost every boulder next to the path lie human excrements and toilet paper. In addition, many summit aspirants throw away their garbage thoughtlessly.

Better chances for fat people?!

In the end on the ground

Never before I have seen on a mountain so many unreasonable summit aspirants overestimating themselves as on the almost six-thousander, located south of the equator. For example, the British teenager who was reeling already at about 4000 meters, with glassy eyes. He said he was just tired. His expedition leader first ignored our suggestion that the boy was suffering from high altitude sickness. The same expedition leader had told me the day before that according to his experience, fat people had a particularly good chance of reaching the summit. The reason he gave: Fat people were also moving slowly in everyday life, and that was just the right tactic on Kilimanjaro.

Wheeled stretchers  in continuous use

I saw Koreans, who looked as exhausted after the ascent to Kibo Hut as Hermann Buhl in 1953 after his legendary solo summit push on Nanga Parbat. A few hours later, they headed for Uhuru Peak, filled with Diamox, as the empty blister packs on the toilet proved. Some had to be carried down the mountain and then transported downhill with wheeled stretchers. No day passed without such rescue operations. Even though there is not yet a mountain rescue in the narrower sense on Kili. Hyperbaric bags for first aid at the Kibo Hut? None. When our doctor from the University of Marburg temporarily used bottled oxygen to treat a man suffering from high altitude sickness, he was asked by the suddenly very nervous officer on the spot whether the patient really was in mortal danger.

Landing sites, but no helicopters

Landing site

Although there are some helicopter landing sites on the Marangu route, they are so far only used by birds. After being transported down with the wheeled stretcher, the altitude-sick people are loaded into a jeep above Horombo Hut at 3,700 meters and driven down a dusty piste to the lowlands. Serious cases can only be treated in the University Hospital of Moshi. The transport takes a lot of time, which can decide about life or death in an extreme emergency.

Deaths are hushed up

Glacier in first daylight

About the climbers who die on Mount Kilimanjaro from high altitude sickness is only spoken behind closed doors. In the week before our arrival at the Horombo Hut two climbers had died there after their summit success, we were told. The two had gone to sleep and did not wake up again. Had they overestimated themselves and underestimated the alleged “hiking mountain”, like so many others on Kilimanjaro? I met summiteers who reached the highest point in just three (!) days. Most took five days to overcome the about 4.000 meters to the summit – to short to properly acclimatize.

Main thing: the summit certificate

Last view on Kili

Above all, I missed two things on Kilimanjaro: humility and respect. Humility before the technically easy, but nevertheless high mountain. Respect for the limits of one’s own ability to perform and the possibility of suffering from high altitude sickness. Humility before nature, which we should consider as a gift. Respect for the local guides, who have so much more Kili experience than the guests from abroad. Instead: with tunnel vision to the summit, the main thing is that the summit certificate is soon hanging on the wall.

Olympus Mons, giant mountain on Mars

Compared to the highest peak on Mars, Mount Everest is a dwarf. Olympus Mons rises 26 kilometers above the surface of the red planet. However, this is not the reason why the German Aerospace Center (DLR) deals with high altitude sickness. For a – as I find, very interesting – study, the DLR is looking for mountaineers, who will ascent in the period from 7 to 20 August after a night on the Gnifetti Hut (at 3,647 meters) to the Margherita Hut. The “Capanna Regina Margherita” is located on the summit of the Signalkuppe in the Valais Alps and is, at 4,554 meters, the highest building in Europe. The DLR scientists want to find out whether it helps against high altitude sickness if climbers are sleeping with a raised upper body. The test persons will use wedge pillows, which ensure that they are raised by 30 degrees. In intensive care units in hospitals such pillows have been used successfully for a long time.

Mountaineers who want to participate in the study at the Regina Margherita mountain hut in August can either register by email at ams@dlr.de or register at the valley station in Alagna or the Gnifetti Hut with the DLR study supervisors. I have talked to Dr. Ulrich Limper who heads the study. The 35-year-old doctor has been working at the DLR for three years.

Dr. Limper, why is an aerospace center interested in the health problems of mountaineers? Are there similarities between astronauts and climbers?

Ascent to the Margherita Hut

Let’s start with the astronauts: They have problems with their eyes when they return from long-term missions in the space station. This is called the “VIIP (Visual Impairment and Intracranial Pressure) Syndrome”. Sight is restricted. It has been found that in weightlessness the blood is pumped to the head and stays there because gravity is missing which could pull it down again. High altitude sickness has a very similar cause. If there is a lack of oxygen, the arteries, the vessels which lead to the brain, dilate in order to transport even more blood to the brain. The veins, which carry the blood back from the head, obviously do not have the capacity to dilate accordingly. Therefore, the blood accumulates in the head, leading to the usual symptoms of high altitude sickness such as nausea and headache.
Furthermore, in the future astronauts e.g. on missions to Mars will stay in artificial atmospheres similar to those in the high mountains: low pressure, up to a certain level also lack of oxygen. This makes it so exciting for us as space physicians to think about mountaineers.

Capanna Regina Margherita at 4554 meters

This suggests that mountaineers should be super-qualified to set off for space.

Of course these are quite different challenges. But, in principle, you are right. High-altitude climbers are often very cool-headed people who can deal with extreme situations and can act very rationally. Whenever the European Space Agency is looking for new astronauts, in a first step they hand out a questionnaire, where these things are queried. You can score points if you climb or dive in your spare time, doing all these things where you have to control your body.

A pillow under the head as a recipe against high altitude sickness? That sounds almost too simple to be true?

It is a very pragmatic approach. We do not assume that we can avoid high altitude sickness, but it should be a puzzle part in the overall concept. We want to show that the people who use the pillow as something like a physical therapy are less likely to suffer from altitude sickness than those who don’t use it. We assume that at night the blood accumulates in the head even more, because you are lying flat. That’s why mountaineers feel even worse in the morning than in the evening. This was proved by a study we made last year.

The approach is not new. I quote from a book on high altitude adaption by the German physician Klaus Mees from 2005: “It is often helpful to raise the upper body, e.g. with a backpack or clothing below the sleeping mat or sleeping bag.”

Everest ER

It’s true, this recommendation exists. But we also want to prove scientifically that it works. If you spend a night in a mountain hut, you will not find anyone who really does it. Even if you look on Internet at pictures of climbers suffering from high altitude sickness in Everest Base Camp or elsewhere: They all lie completely flat, wear an oxygen mask, have  a saturation clip on their finger, but almost no one’s upper body is raised. If we can prove that sleeping with a raised upper body is really a simple and effective measure against altitude sickness, we could make the case for it even more vehemently.

You will only record the test persons’ oxygen saturation and pulse and use a questionnaire to investigate the symptoms of altitude sickness. Is this method not too rough to capture the micro-processes that may occur in the brain?

We will not be able to say anything about the mechanism of altitude sickness, but only about this: Does the method work or not? If we were to explore the mechanism, it would make more sense, instead of going to a mountain hut, to use an DLR altitude chamber, where all conditions can be controlled and the micro-processes can be looked at. However, our study has a very pragmatic approach. Every mountaineer will benefit if we prove the success of the therapy – or not. Therefore, it makes sense to carry out the study as simply as possible. We do not take any test persons to the mountain, but work with climbers who are on the huts anyway. We assume that the less they feel burdened in their mountaineering, the more they will join in.

If your hypothesis is correct, the wedge pillow should be in the rucksack of every high-altitude climber and Mars astronaut, shouldn’t it?

It would be at least not wrong to take it with you.

Mount Everest

Death on the Everest winter expedition: However, none of the climbers died but a government official. According to the Kathmandu-based newspaper “The Himalayan Times” the liaison officer, who was to accompany the winter expedition of the Basque Alex Txikon on behalf of the Tourism Ministry, died of high altitude sickness. The man passed away on the flight from Dukla (4,600 meters high) to Lukla (2860 meters) where he was to be treated in the hospital. The Spaniards Alex Txikon and Carlos Rubio want to climb Mount Everest without bottled oxygen this winter. The team has meanwhile – as reported – pitched up Camp 1 at 6,050 meters above the Khumbu Icefall.

Cash up and stay away

The rules for expeditions in Nepal, laid down in the so-called “Tourism Act”, require that each team must be accompanied by a liaison officer. Each expedition has to pay 3,000 US dollars – and provide tent and food to the government official in the base camp. However, it’s rather the exception than the rule that the liaison officers really find their way to the foot of the mountain. And when they get there, they usually stay only for a short time. The “Himalayan Times” asked the Everest expeditions after the spring season 2016: Of the 32 deployed liaison officers only 17 had reached the base camp. Six of them returned the same day, five more in the following three days. Only six liaison officers stayed at the foot of the mountain for more than two weeks. Many expeditions meet their liaison officer only twice: during the briefing before and the de-briefing after the trip – in Kathmandu.

NMA: one liaison officer per mountain

R.I.P.

After an Indian couple in 2016 had obtained their Everest certificates by fraud using fake summit pictures, another discussion about the questionable system of liaison officers had flared up. Government officials had confirmed with their signature that the Indian mountaineers had been on the summit. The Nepal Mountaineering Association (NMA) has proposed to the government to send only one liaison officer per mountain who really stays in the base camp and fulfills his duties. The liaison officer of the Everest winter expedition had obviously taken his job seriously.

Oswald Oelz

“I will climb until I am dead,” says Oswald Oelz, sitting opposite me recently at the International Mountain Summit in Bressanone. The 73-year-old native of Austria lives as a retiree in an old farmhouse in the Zurich Oberland region in Switzerland. “I have a farm with sheep, parrots, ducks, geese, chickens. I write, read a lot, climb. And I travel around the world.” Oswald called “Bulle” Oelz scaled Mount Everest in 1978, on the same expedition, during which Reinhold Messner and Peter Habeler climbed the highest mountain on earth for the first time without bottled oxygen. Oelz succeeded first ascents in the Alps, in Alaska, Jordan and Oman. Until 2006 he worked as chief physician at the “Triemli hospital” in Zurich. The professor also researched in the field of high altitude medicine.

Oswald Oelz, you are a mountaineer and a doctor, you have got to know both worlds. Time and again, there are fatalities in the high mountains due to high altitude cerebral or pulmonary edema. Has the climbing community learned nothing over the past decades?

The climbing community has learned nothing insofar as they still climb up to altitudes where a human being doesn’t really belong. Above 5,300 meters, man is not able to survive in the long run. Nevertheless, he goes up there. This is a charm, a thrill. If he is sufficiently acclimatized, he can stay up there for a shorter or longer time. The problem is that, on the one hand, people are willing to ascent who are less fit for high altitude and, on the other hand, they climb too fast too high. The typical example is Kilimanjaro, where you climb up to almost 6,000 meters within five days or even less. There is a very high death rate. Per year about twenty so-called climbers die. That is kept strictly under lock by the government.

Oelz on the summit of Mount Everest

On Everest, reportedly two-thirds of the summit aspirants are prescribed performance enhancing drugs to increase their chances of summit success. Who is responsible for doping on the mountain, the climbers themselves or rather the doctors who hand over these drugs to them?

I have no idea to what extend climbers are doped on Everest. But I have no doubt that there are quite a lot using the “three D”: Diamox, Dexamethasone and Dexedrine. The mountaineers take Diamox for a long time, then Dexamethasone, a cortisone preparation, during the ascent and finally, to mobilize the last resources, Dextroamphetamine – a poison which was given to the Stuka pilots in the Second World War to make them more aggressive. In the history of alpinism, many climbers have died as a consequence of taking these amphetamines on Nanga Parbat and other mountains because they pushed themselves beyond their limits. Obviously this medication is prescribed by doctors. On the other hand, these drugs are also available illegally. Today you can get everything you want provided that you pay for it.

Actually, Diamox and Dexamethasone is emergency medicine.

This is certainly also a cause of the problem. I think Diamox is the most harmless of these. If someone makes this brutal ascent of Kilimanjaro within five days up and down, he is almost certainly a candidate for high altitude sickness. This can be avoided to a great extent by taking Diamox. It has few side effects. The beer tastes horrible, which is the worst side effect. You have to drink a little more water because it has a diuretic effect. But otherwise I personally recommend Diamox, if someone who wants to climb Kilimanjaro and has problems with high altitude asks me.

Climbing in Jordan

You were on top of Mount Everest in 1978, along with Reinhard Karl (Karl was the first German on Everest, he died in an ice avalanche on Cho Oyu in 1982). Four years later you suffered from a high altitude cerebral edema at Cho Oyu almost killing you. How can this be explained? You really had to assume that you can handle high altitude well.

I was not able to bear high altitude as good as, for example, Reinhold Messner but quite properly, when I had acclimatized. But I always had this time pressure. I was working in the hospital. I wanted to get as high as I could as quickly as I could in the few days I had left for mountaineering. In 1982, I had a severe high altitude cerebral edema. In 1985, on Makalu, we moved within nine days from Zurich up to 7,000 meters. There I had a life-threatening high altitude pulmonary edema. I would have died if I had not tried for the first time a therapy which then worked. I took the heart medication Nifedipine, which lowers the increased blood pressure in the pulmonary circulation, which is especially crucial in the case of a high altitude pulmonary edema. That saved my life. Afterwards I have made the appropriate studies, and we were able to prove that this drug can be used as a prophylaxis for people who are predisposed to high altitude pulmonary edema. In my opinion this isn’t doping. Furthermore we could show that in case someone is already suffering from a high altitude pulmonary edama, it can improve the situation significantly. Meanwhile, it has been found that the same effect can be achieved by Viagra. It widens the vessels also in the lungs, not just below. Thus the increased pressure in the pulmonary circulation decreases, and the people are doing better. This is, of course, more fun than taking a heart medication.

You referred to prophylaxis. Is it really practiced?

I know people who do it. In 1989, we published a work in the “New England Journal of Medicine”, the leading journal in the medical scene, in which we showed that people with a predisposition to high altitude pulmonary edema can be protected to a certain extent by prophylaxis with this cardiac medication. People who e.g. suffered from a high altitude pulmonary edema even in the Alps at an altitude of 3,000 to 3,500 meters should be recommended such a prophylaxis. Of course, it would be wiser to tell them: “Stop this stupid mountaineering, instead swim, run or whatever!” But these people are not teachable. They want some medicine.

“An embarrassing spectacle”

You had the privilege of traveling in the Himalayas at a time, when it was still a deserted mountain region without any tourism. How do you think about what is going on there today?

I follow what’s happening today in the Himalayas with fascination. It is unbelievable what the young really good climbers do in the difficult walls of the seven-thousanders. What I am following with great sadness is what takes place on Everest and on the other commercialized eight-thousanders. These endless queues of clients who are pulled up by their Sherpas – I think that’s an embarrassing spectacle.

Childhood dream

Eric Arnold had tried to climb Mount Everest for four consecutive years. In 2012, he had to turn around 250 meters below the summit. In 2013, he was stopped by an injury before the start of the expedition. In 2014 and 2015, he got no opportunity for a summit attempt because both seasons ended prematurely after avalanche incidents. In a television interview before his fifth expedition, Arnold said that it was his childhood dream to climb Everest: “A poster showing Everest was hanging above my bed.” He had never lost this dream, Eric said then.

Climbing with her husband

Maria Strydom, a university lecturer from Melbourne, had scaled along with her husband Robert Gropel three of the “Seven Summits”, the highest mountainss of all continents: Aconcagua (6,962 m, South America), Denali (6,190 m, North America) and Kilimanjaro (5,895 m, Africa). Also on Everest, the Australian couple was climbing together.

No knowledge on treatment of children

Prof. Thomas Kuepper

I wanted to know whether there was scientific evidence about how children respond to high altitude: Is there a greater risk for them to suffer from high altitude sickness? Can there be long-term effects? “Basically, there is no difference between children and adults in terms of the symptoms and the incidence of altitude sickness and neither in terms of the time they need for acclimatization”, says the scientist. “However there is no knowledge of how to treat children if they suffer from the particularly severe forms of high altitude sickness.” In other words: If Tyler Armstrong suffers from a pulmonary or cerebral edema, he will probably be given the emergency medicine used for adults – although there has not been sufficient research to date on whether it makes sense for children, and if so, at what dosage.

Higher risk of frostbite

But high altitude sickness is not the only danger, Professor Kuepper writes to me. “Due to their different physiology and body proportions, children have less to set against environmental impacts. For example, there is a higher risk of hypothermia.” In my opinion, that should be reason enough for parents not to expose their children to extreme heights. Professor Kuepper says there are no ifs, ands or buts on this issue. For him the ascent of a twelve-year-old boy to the top of Mount Everest would be “utter nonsense and pure narcissism of the parents”.