Saving Lives on the Shadow of Everest: Experience at HRA Pheriche Aid-post

In the fall of 2024, I served as a volunteer doctor at the Himalayan Rescue Association (HRA) Aid Post in Pheriche, which was nestled in the Everest region. Our Medical team comprised four volunteer doctors- two from the Netherlands, one from the USA, and myself from Nepal. Together, we encountered a spectrum of altitude-related illnesses, including High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE), and Acute Mountain Sickness (AMS). We also had a daily free Altitude Talk session with interactive lectures on the recognition, prevention, and management of various types of altitude-related issues mainly focusing on AMS, HACE & HAPE.

Cases: AGE mimicking HACE symptoms, Acetazolamide Overdose

One case that stood out was a patient with severe Acute Gastroenteritis(AGE) complicated by electrolyte imbalance, likely hyponatremia. Initially, the symptoms mimicked HACE, with the patient presenting drowsiness and an unsteady, ataxic gait. He had been living in Lobuche for the past two months, which led me to consider HACE as a less likely diagnosis. This was true as the patient’s status improved the next morning when I treated him with adequate fluid and electrolytes. I also encountered a patient with Acetazolamide overdose. She was taking 500 mg of Acetazolamide twice daily for 10 days even before starting Trekking as prophylaxis for altitude illness. She was also under antihypertensives as well. She presented to our clinic with light-headedness and features of electrolyte imbalance. Though we didn’t have access to the Arterial Blood Gas(ABG) and serum electrolytes test, I figured out that her symptoms must be suggestive of Metabolic Acidosis and electrolyte disturbance along with additive effects of Acetazolamide in decreasing BP. Her BP was on the low normal and there was no orthostatic hypotension.

Beyond the clinic, the region itself was breathtaking. I hiked to Everest Base Camp, Kalapathar—where the view of Mount Everest left me spellbound. I also explored the nearby AmaDablam Base Camp and Banana Lake. Above everything, It was that sense of purpose I felt while treating patients, particularly porters who lacked access to even basic healthcare. At the HRA clinic, we provided almost free medical care to Nepali people, ensuring that financial barriers wouldn’t stand in the way of life-saving treatments.

One particularly memorable case was a severely ill porter suffering from HACE. After initiating treatment, we saw remarkable improvement within just three hours, and we could also manage a seat for the porter in a helicopter to evacuate him down to Lukla. Such experiences made me feel that I was making a difference in the lives of people.

While there were financial challenges of working as a volunteer doctor, this journey offered me some of the most rewarding experiences as a doctor, deepening my passion for providing healthcare to those in challenging, remote areas.

Dr. Sujan Timilsina
Volunteer Doctor,
HRA Pheriche Aid Post, Fall 2024

In Picture: Dr. Timilsina hiking in a snowy terrain, Island peak in the background