The Everest Economy

"This helicopter rescue was medically necessary."

I never thought I would think so carefully about charting these six words.

It's no surprise to anyone who has seen David Breashears' IMAX movie, "Everest," or read Jon Krakauer's "Into Thin Air" about the multiple deaths during the 1996 climbing season that the growing crowds on Everest have been criticized for compromising climber safety. According to a recent Washington Post article, an estimated 670 climbers attempted to summit the highest mountain in the world during the week of May 19, 2013 ALONE (the peak of this year's climbing season). That's nearly 100 summits per day. 

Why the draw? People love superlatives, for one. Further, compared to K2 and some of the other Himalayan peaks, Everest is not as technically difficult to climb, so it doesn't exactly weed out less experienced climbers or people who have money to pay for guides. What does make it difficult, of course, is the altitude. Even off the mountain, thousands of tourists make the trek to Everest Base Camp (EBC) every season, and invariably, some climbers and trekkers get helicopter rescued back to Kathmandu for acute mountain sickness, HAPE, HACE, diarrhea and dehydration, or some other obvious reason, such as this poor chap's frostbite (posted with patient permission):

Sometimes, however, the reason for medevacs is less clear. To be fair, descending to Kathmandu from higher elevations will obviously improve many of a patient's altitude-related symptoms; by the time they get to our clinic, some have nearly completely recovered and often go home the same day. Still, it's reasonable to give them the benefit of the doubt regarding how poorly they were functioning at altitude since we weren't able to clinically assess them at that time, and if the story fits.

But now throw this into the mix: https://www.thebmc.co.uk/helicopter-rescue-nepal

If you're too lazy to read the article, it discusses how Nepalese trekking and charter companies try to profit off helicopter rescues of clients that may not be medically necessary. They do this by convincing clients they are not well enough to continue, double-billing or overcharging clients' medical insurance companies for rescues, or trying to piggyback less ill trekkers or climbers onto a flight for a truly sick client and trying to bill the less ill clients' insurance companies for that same flight. Reportedly, even some of the Kathmandu hospitals pay kickbacks to trekking & charter companies for bringing these patients to their facilities. It seems everyone is in on the middle-man action. CIWEC, fortunately, still has a moral compass.

The challenge as a physician in these circumstances is, ultimately, to decide if a patient's helicopter evacuation was truly medically necessary when drafting our letter to their insurance company. If it isn't, the patient is stuck with a bill for tens of thousands of dollars. Nobody said this job was easy.

I met a British climber, Chris, on the bus back from Pokhara who happened to run into Reinhold Messner, who is currently filming near the Annapurna region. Messner has been referred to as the world's greatest mountaineer, having been the first to summit Everest without supplemental oxygen, and the first to summit all 14 of the world's peaks over 8,000m (>26,246.7ft for you Yankees). Chris' discussion with Messner revolved around what truly makes a great mountaineer. Self-sufficiency was a big part of the answer. Messner's opinion is that "one should climb [Everest] by fair means, or not at all."

In an era where people are discussing installing a ladder on the Hillary Step (the final pitch requiring some rock climbing skills before reaching the Everest summit) to improve traffic flow, one wonders what has happened to self-sufficiency & Messner's school of thought. Part of the point of doing Everest is the physical challenge, and it's not the same if you add components of artificiality to it. How much further will things be taken in this booming tourism economy? Why not just install a tram?! 

Combine the increasing crowds with this underground movement to profit from heli rescues, and you've got a real mess. Everest summiteer & blogger Alan Arnette offers some possible regulatory solutions to address who should be allowed on the mountain: http://www.alanarnette.com/blog/2013/05/28/everest-2013-ladder-on-the-hillary-step-a-bad-idea/ 

In short, there are ways to make things in the Everest region safer without making them easier.

Similarly, if you plan to trek in the Himalayas, your best insurance is to remember that nature calls the shots. These mountains are no joke, and you can't approach them with the sort of desensitized attitude that some tourists have when approaching wild animals and waterfalls in national parks. If you get sick, you should be treated, of course. But you can minimize your risk if you properly, legitimately train for the trip, know your limits, and do your research on trekking companies. Being a tourist in Nepal helps feed the local economy; the hard part is feeding the right economy.