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To the Editor-in-Chief:

Mount Kilimanjaro in northern Tanzania attracts 40,000 trekkers each year and is regarded as “Everyman's Everest.” Although most trekkers' determination to summit is high, their knowledge of the risks associated with climbing to high altitude is understudied. In 2007, Merritt and colleagues[1] investigated the knowledge levels of trekkers in Cuzco, Peru, and found that 51% of trekkers rated their knowledge of acute mountain sickness (AMS) as low. Climbing Mount Kilimanjaro normally takes between 4 and 7 days. The longer the trek, the greater the opportunity to acclimatize and thereby reduce the risk of altitude-related illness.

On a recent university trip to Mount Kilimanjaro, our group of postgraduate nurses and doctors from across Australia were astonished at the high number of untreated, symptomatic high-altitude cerebral edema (HACE) cases observed. It is defined as the onset of ataxia, altered consciousness, or both in a person with AMS or high-altitude pulmonary edema (HAPE).[2] HACE is considered the end stage of AMS.[3] On our descent, we noticed 10 people who appeared to be suffering from HACE, with clear evidence of altered consciousness and ataxia. Many were only able to walk with the physical support of two porters. Trekking guides we spoke to note that in a normal day between base camp at Barafu (4,673 m) and Uhuru Peak (5,895 m), they see between 10 and 15 cases of trekkers with HACE symptoms being encouraged to climb higher to summit or being assisted down in the late afternoon.

Although some of the guides do carry oxygen, the trekking guides we spoke to were not trained in how and when to use this equipment. Indeed, when we stopped to offer assistance to one man, his guide did not want to offer him oxygen as he said it was “dangerous.” This guide had to be shown by our team how to use the oxygen bottle and mask. The trekker's symptoms were relieved upon using the bottled oxygen and he continued his descent down to Millennium Camp (3,810 m). Left at 5,000 m, with no additional oxygen, his ataxia and altered consciousness would have resulted in a very slow descent and possible death. Death from HACE results because of brain herniation.[2] Another guide accompanying a trekker with HACE did have an oxygen cylinder, but had no tubing with which to administer oxygen. There are no reliable statistics on the number of HACE-related morbidities or mortalities on Mount Kilimanjaro per year, which are thought to be around 8 to 10 deaths per year.[4]

In her recent article in this journal, Pattenden and colleagues explored the number of commercial mountaineering expeditions carrying medication on some very popular climbs including Mount Kilimanjaro, Everest Base Camp, and Aconcagua.[5] In the light of our experience, it would be beneficial to do a more detailed analysis on the preparedness of expedition groups to administer oxygen when required. Unlike the risks of handing out medication to trekkers by untrained expedition employees, the dangers of using oxygen in trekkers are low—but the benefits are huge and potentially life saving. In medical practice, “uncontrolled” oxygen therapy can be harmful for patients with end-stage chronic obstructive pulmonary disease (COPD). Patients with end-stage COPD would be unable to participate in treks at high altitude.

Among tour companies and trekkers there needs to be greater awareness of the dangers of HACE, AMS, and HAPE. Early identification of the symptoms followed up with the treatment could possibly reduce the number of deaths each year on Mount Kilimanjaro.

There are currently no medical facilities on Mount Kilimanjaro to assist trekkers suffering from mountain sickness. We propose that consideration should be given to use some of the money raised by trekkers entering the National Park to set up a staffed medical help station at the Stella Point (150 m below Uhuru Peak) and part way down to Barafu Camp (4,673 m). These outposts could contain oxygen and a stretcher and would only need to be staffed by a trained individual for a few hours each day. Most trekkers summit in the early morning and descend by late morning back to Barafu or Millennium Camp.

  • Paul Gordon John Welch* and

  • David Andrew Dyke Symmons

  • *Medical Education Unit and Emergency

  • Department, The Townsville Hospital, Townsville,

  • Queensland, Australia

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