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reed magazine logoSeptember 2010

Adventures in the First Person

Life and Death in the Valley of the Moon

By Madeleine Martindale ’84

Madeleine Martindale

High in the wild remote Khumbu region of Nepal, at an elevation of 14,500 feet above sea level, lies an area known as the Valley of the Moon. In this landscape—stark, windswept, and stunningly beautiful—the Himalayan Rescue Association operates a health aid post in the village of Pheriche. This is the highest permanent clinic in the world, and despite its humble beginnings (originally it was housed in a dirt-floor yak hut) and its lack of modern medical equipment, the clinic is renowned among mountaineers for the lives the medical staff there have saved.

The aid post consists of several exam rooms, a small pharmacy closet, and living quarters for a staff of five. There are no lab or radiology services and the autumn temperatures at night hover around 0°F. Solar panels and a windmill generate enough electricity to recharge small electronics, support electric lights, and power two prized oxygen concentrators. The medical equipment has mostly come from international donors and research studies over the years, resulting in an eclectic collection that includes an ancient hyperbaric chamber, chest tubes, IV antibiotics, and an ECG machine.

It is difficult to convey the sheer remoteness of this location. There are no wheeled vehicles of any kind in the Khumbu; goods are transported by yak and porter. Rugged high-altitude horses can be rented for a few hundred dollars, but the ascents and descents are mostly too steep for carrying Westerners. The nearest airstrip is several days away, often shut down by bad weather. If a patient cannot manage the long and brutal hike to the nearest medical facility, a clinic in Kunde at 12,000 feet, the only remaining option—weather permitting—is evacuation by helicopter, which costs about $5,000, paid “up front” by credit card or cash.

The aid post was founded in 1973 to reduce casualties in the Nepal Himalayas. During the fall and spring trekking seasons, the clinic is staffed by two volunteer physicians, a Sherpa or Nepali medical assistant, and a cook. Medical care for locals is free or nearly free; foreigners are asked to pay. About half the 350+ patients seen at Pheriche each season are Nepalese, many of them lowlanders who suffer from the same problems with altitude as foreigners, made worse by the stresses of working with inadequate equipment and clothing, carrying heavy loads, and meeting the demands, however un­reasonable, of their employers.

Working solo one afternoon, I received a call from a trekking company in Kathmandu. One of their porters had fallen almost 1,000 feet from a high pass to the east of the clinic. The trekkers he was working for had watched him fall, saw that he was alive but injured, and then abandoned him there in favor of their adventure trekking goals. Sadly, not an unusual scenario. Admitting the prognosis was poor, the company’s owner requested that I trek to the site “to provide moral support” in the porter’s last hours.

Abandoning the post could mean the difference between life and death for others later that night. If the porter had survived the fall, he would need far more intensive medical support than we could provide at Pheriche. Instead, I suggested evacuation by helicopter, which would be faster in any case.

Later that evening, a group of Sherpas appeared at our door, utterly exhausted. They had carried the injured porter on their backs for six hours through darkness over treacherous ground. He was tied into a doko (basket), set down on the floor amongst the crowd of his comrades, in dire straits— shaking from trauma and hypothermia, moaning through a clenched jaw, eyes swollen shut, his clothes soaked with blood and urine. I was surprised his spine had survived not only the fall but the many hours of jostling while curled up in the basket; he was not paralyzed.

As I peeled the hood of his jacket from his head, strips of his scalp came away with it, everything stuck together with clotted blood like thick glue. His left orbit was as big as a tennis ball, and an ominous protrusion of his temple suggested a cranial fracture. My initial exam revealed no other major injury, but given the nature of his fall, he had the potential for occult fractures, splenic rupture, collapsed lung, crush injuries, and the like. Under these conditions, the prognosis was grim indeed.

reed magazine logoSeptember 2010