Medical Team Battles Challenges in the Himalayas

Published May 30, 2017

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Clinicians from UNMC and Nebraska Medicine spent one month researching and trekking in the Himalayas. L to R: Walker Thomas; Eric Harvester, RN; Daniel Kalin, MD; Brad Fremming, MD, PharmD; and Tim Rush, MD.

Everest. The very word conjures up visions of snow-capped mountains and a way of life so far removed from our experience in the Midwest that it is difficult to imagine. 

In early 2016, the UNMC Department of Anesthesiology was asked to participate in a month-long research endeavor to Mount Everest Base Camp (18,500 ft.), by the world-renowned group Xtreme Everest. Xtreme Everest has performed research at Mount Everest for over a decade and generated dozens of publications in some of the most highly regarded scientific journals.

How would six clinicians from UNMC and Nebraska Medicine prepare for a month of research and trekking in the Himalayas? Where would we even begin? 

The logistics of organizing this was a daunting task. Our traveling group consisted of three physicians (Drs. Brad Fremming, Dan Kalin, and Tim Rush), one nurse anesthetist (Michael Hamilton), one nurse (Eric Harvester), and one cardiac sonographer (Walker Thomas). Harvester and Thomas also served as ambassadors for the Inter-Professional Academy of Educators from UNMC. Instrumental in making this trip a reality were Dr. Andrew Patterson, a Nebraska Medicine anesthesiologist and executive vice chairman of the UNMC Department of Anesthesiology; along with Julia Hoffman, a clinical research nurse in the department. The many months of forward planning included team meetings, international phone conferences with our UK colleagues, development and IRB approval of study protocols, acquisition of equipment and physical fitness training.

 

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Their mission was to evaluate the effects of high altitude and low oxygen levels on right-side heart function using non-invasive chest-based ultrasound referred to as transthoracic echocardiogram.

Our mission was to evaluate the effects of high altitude and low oxygen levels on right-side heart function using non-invasive chest-based ultrasound referred to as transthoracic echocardiogram. We also measured lung edema and the detection of blood enzymes associated with cardiac muscle injury and stretch. These tests were performed at 3 altitudes; 4,600 ft., 11,300 ft. and 14,000 ft.

Upon arrival in Kathmandu (4,593 ft.) on March 30, 2017, we set up a basic lab. Over a two-day period, approximately 50 study participants were consented and the initial testing performed. Following Kathmandu, we flew to Lukla (9,317 ft.); the beginning of our long, uphill trek base camp. All of our research supplies were carried on the back of a person (called a Porter) or a Yak. The trail started out wide and generally well-groomed. As we gained elevation, it became more narrow and arduous. 

Our second session of testing was conducted at Namche Bazaar (11,283 ft.), complicated by cold temperatures and high altitude. These two factors impacted the function of our blood analysis machines. The lab lacked most modern conveniences but we were still able to carry out our research. Our third testing site was in Pheriche (14,010 ft.), located high in the Himalayas on a windswept valley floor. The challenges of testing in Pheriche were similar to the challenges in Namche Bazaar: cold and altitude. To keep the machines warm we had to improvise a heating system using boiling water in Nalgene bottles. Using these bottles as makeshift radiators and a small yak-feces burning stove, we made it through the two days of testing.

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Freezing cold temperatures and a complete lack of modern conveniences were standard for the majority of the trek.

This expedition presented challenges beyond performing research in extreme environments. Our team battled progressively lower oxygen - 50 percent the amount of oxygen in the air as compared to Omaha. Freezing cold temperatures and a complete lack of modern conveniences were standard for the majority of the trek. We ascended to heights that the majority of people will never attain in their lifetimes and battled the very real danger of acute mountain sickness in order to conduct research near the top of the world. This was certainly not easy - however, it was successful.

Our team returned to Omaha on April 24, 2017, exhausted but proud of the important work that we had accomplished. 

 

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