If you trek into the mountains for two weeks from Kathmandu, you are two weeks’ walk from Kathmandu. This fact often does not impress itself on trekkers until they become sick or injured on the trail and need to return to Kathmandu. In recent years, communication from the mountains to Kathmandu has improved dramatically with the presence of both microwaved linked phones and satellite phones. The police and the army posts throughout the country also have radio capability. There are a few reliable medical posts in the hills (the HRA aid posts at Pheriche and Manang and the Khunde Hospital are all staffed by Western doctors), but most accidents or illnesses will occur in the absence of reliable medical care. If you find yourself ill or injured in the mountains, here are the steps to take to get rescued.
First of all, don’t panic. If someone falls, take time to assess the situation: suspected broken bones may only be bruises; a dazed person may rapidly become more oriented, and be quite all right in an hour. If it is severe AMS, descend with the victim; do not wait for help. In most areas of Nepal, some kind of animal will be available to help transport a sick or injured trekker. In western Nepal, ponies are common; in the mountains, yaks are usually available. As extraordinary as it may seem, many Nepalis are both willing and capable of carrying Westerners on their backs for long distances. Even if helicopter evacuation is considered, it may be necessary to transport the patient to a place where it is possible to land the helicopter.
If you happen to be near one of the airfields in the hills, you may be able to arrange a seat on a scheduled flight. By negotiation, space can usually be found for a seriously injured or ill trekker, or a charter flight might be arranged, but airport officials, are quite unsympathetic to trekkers who are merely demoralised by the unexpected hardships of trail life and hope to jump the queue in order to get out sooner. If there is no nearby airfield, or you have missed the available flights, then the only alternative is to request a helicopter rescue flight.
In 1999, more than 120 helicopter rescues took place in Nepal. In 2000, this number was almost surpassed in October and November alone. There are several private airlines that operate scheduled helicopter passenger services, and whose helicopters can also be chartered for rescue. The cost of rescue is between USS1000 and USS1800 per hour, with average flight times of two hours. Helicopter rescues involve three important steps:
Getting the Message to Kathmandu
Satellite phones are now the major means of communication from most places. Police radios are available in places where phones are not. Regular telephones exist in a number of trekking destinations as well. See the appropriate chapters for the location of phones and emergency radios. Invariably, local people will know where the nearest radio post or telephone is. These satellite phones or radios will usually be within four to eight hours’ walk. If you can send a reliable Westerner, it may improve the chances of passing an accurate message, but if you need to send a Nepali, you can write the message out carefully, using only capital letters. If you are trekking with an organised trekking company, the message should go to the trekking company, and they will arrange the helicopter rescue. If you are trekking on your own, the message should go to your embassy or consulate in Kathmandu. Make sure you have the phone number of your embassy or consulate before you go trekking.
Helicopters will rarely fly on a rescue mission without someone guaranteeing the payment in Kathmandu by making either a cash deposit or a promise in writing. If you are trekking with an agency, it will usually arrange the rescue. If you have no agency, you will have to depend on your embassy to guarantee payment. Register with your embassy in Kathmandu before your trek. This greatly facilitates arranging a rescue for you if you later require it. The victim is responsible for the cost of the flight. Nepal is much too poor to guarantee free rescue for comparatively wealthy tourists.
Availability of Helicopters
With so many helicopters and pilots in the country now, lack of equipment is rarely a limiting factor. However, mountain weather can restrict flying at any time. Usually the weather is less windy early in the morning, so most mountain rescues take place the morning after the message is received. Most afternoons are too windy to attempt the tricky high-altitude flying involved. Rescue time now varies from as short as an hour (if a helicopter happens to be in the region), to as long as two days (if weather is a problem).
There are three steps you can take in advance to facilitate rescue:
- If you are trekking without a trekking agency, register with your embassy. This greatly facilitates the embassy’s ability to organise a rescue for you.
- If you are trekking with an agency, ask it for written instructions you can carry in case you need to organise a helicopter rescue from the mountains. It is always possible you may have been left behind by the group at some point, and then find you require rescue. If you are unsure of your agency’s ability to organise a rescue, register with your embassy as well.
- If you are not with an agency and your country does not have an embassy or honorary consul in Kathmandu, you should try to identify someone in Kathmandu who would be willing to help organise a rescue for you if you required it.
Flying on rescue flights has made me familiar with the difficulties involved. One of the biggest pitfalls is the rescue request itself. Most helicopter rescue requests describe the victim’s condition as, ‘Very sick’. One such message actually read, ‘No arms, no legs’. The embassies, trekking agencies and pilots will be trying to assess what degree of risk the rescuers should take, based on the perceived urgency of the medical condition. Since messages are often written down, carried by an illiterate porter to an uninterested radio operator, and translated from English into Nepali and back into English, it is difficult to obtain a true picture of the situation.
On the basis of your rescue request alone, the pilots and the doctors involved will have to decide whether to take a chance and fly through bad weather or wait for the usually better weather in the morning. Don’t risk other lives needlessly with unnecessary flights or inadequate information.
Once a request is sent, stay put for at least two days, or make it clear in the message where and how you will be travelling. If you see the helicopter, make an effort to signal it. It is very difficult to pick out people on the ground from a helicopter moving at 145kmh, especially if you are unsure where to look. Try to locate a field large enough to land a helicopter safely, but do not mark the centre of the field with cloth, as this can fly up and wreck the rotors on landing. If you are a trekker who has not sent for a helicopter, do not wave at a low-flying helicopter! We have made a number of unnecessary and occasionally dangerous landings only to find that the people were not involved with a rescue and were just waving.
In the last few years there has been a disturbing trend for tired and disillusioned trekkers to try to charter helicopters out of the mountains. With the increased availability of charter helicopters trekkers now have the expensive option of aborting their trek for rather minimal reasons. Please make sure any such request comes as a charter, and not as a rescue request, so it can be given the low priority such a request deserves.
While helicopters can fly as high as 6000m, they are unable to land and take off above 5500m as the air is too thin to give the rotors sufficient lift. Therefore, there is at present no way to expect to be rescued from trekking or mountaineering peaks.
Insurance that covers rescue is available at low cost in your home country, and a rescue policy has recently been introduced in Nepal, although its effectiveness remains untested.
Almost every trekker will encounter a situation where they are asked to give some kind of medical treatment to a sick Nepali in the hills. The potential patient may just have a headache, or may be covered with severe bums from which he or she will most likely die. The moral dilemma the trekker is occasionally faced with can remain with them long after the trek. There is no simple answer, but I will offer some guidelines to help you think about the problem before you encounter it.
The government of Nepal is attempting to establish and maintain health posts in remote areas. So far, this has not brought medical care to the majority of the people, who often have their own healers, beliefs and practices regarding health. When these prove ineffective, or out of growing curiosity, the local people may consult passing trek- kers, whether they are doctors or not. In many areas there is no understanding at all of the basis of Western medical practice. Ideas we take for granted, such as the relationship of germs to infection, have no meaning to these villagers. A pill can be seen as a form of magic, the shape, size, and colour often having more meaning than an attempted explanation that the medicine will kill the germs.
Thus, some of the medical interactions are based on villagers’ desires to get closer to a form of Western magic. This has created a form of medical ‘begging’, where it is not clear whether the person is indeed ill at the time of the encounter. It is fair and advisable under these circumstances to say you have no medicine. Otherwise the pills are indiscriminately given out at later times, possibly doing someone some harm.
A Nepali person who is clearly suffering from a problem presents another level of dilemma. If you have the expertise to recognise the problem, know your treatment will be effective, and have a way of explaining this to the people involved, there is no reason to withhold treatment from someone who can clearly benefit. If you do not know what is going on, or are not sure of the right treatment, don’t try to give medical help due to misguided compassion. You may do more harm than good, or the treatment failure may stop villagers seeking appropriate Western medical care at a health post in the future.
The fact you are trekking through at that moment does not mean you suddenly have to take on the continuing and insoluble problems of remote village life. The feelings of compassion and wanting to help are natural, but if you see that you truly can’t offer anything likely to improve the situation, don’t feel obligated to ‘do something’. The fact that there are many people in the world who can’t call an ambulance to be rushed to a hospital is a reality that catches many a Western trekker emotionally unprepared. The discovery of these feelings and the processing of your reactions are among the reasons to trek. Perhaps when you get home you might donate money to one of the aid agencies working to solve these very problems.
In summary, the problem remains a difficult one. Try to refer people to local health posts where possible (the Khunde Hospital in the Khumbu is a good example). If this is not possible, determine whether you can definitively help someone and then do so if your resources allow. If you are not sure what to do, you can express your concern but admit you don’t have anything to offer. Nepalis can usually accept this gracefully.