INTRODUCTION The British Services Dhaulagiri Medical Research Expedition (BSDMRE) 2016 took place throughout April and May 2016. The expedition consisted of one main team aiming to summit Dhaulagiri, a high altitude development team (HADT) which would attempt Tukuche and eight teams which would trek the Dhaulagiri Circuit. This report will detail the activity of Trek Team 5 which consisted of six members of the Royal Navy and Royal Marines Mountaineering Club.
AIM The aim of BSDMRE 2016 was to conduct high-quality adventurous training and concurrent medical research, with multiple trekking teams aiming to complete the Dhaulagiri circuit, the HADT aiming to summit Tukuche peak(6900m), and a main team aiming to summit Dhaulagiri(8167m). Participation in the medical research would be voluntary and would be conducted by the Royal Centre for Defence Medicine in collaboration with Leeds Beckett University and the University of Oxford.
ADMINISTRATION Due to the high number of personnel involved in BSDMRE, all administrative functions were devolved to individual trek teams so that each trek was developed as a unique sub-expedition. Each team was required to submit its own JSATFA, secure its own funding and organise its own travel outside of Nepal.
Far Frontiers was chosen by BSDMRE as the expedition travel company. With many years of experience organising and co-ordinating expeditions to Nepal, Far Frontiers fulfilled the role of travel agent for all BSDMRE teams. CILOR was requested for the duration of the exercise in accordance with Reference Band actioned through HMS Heron Catering Office. All personnel were accommodated in accordance with arrangements made by Far Frontiers Expeditions.
TRANSPORT AND TRAVEL Flights were booked with Jet Airways. Trek Team 5 travelled together from Heathrow to Kathmandu with a short stop-over in Delhi. All travel within Nepal was organised and financed through Far Frontiers as part of the expedition package.
EQUIPMENT All tents, sleeping mats, mess tent and cooking equipment was provided by Far Frontiers Expeditions. Personal equipment was made available through the Loan Pool Stores at MoD Bicester. However, all team members were already suitably equipped for UK winter walking and this facility was not utilised. As a safeguard, all personnel carried an ice axe and crampons for emergency use only.
MEDICAL There was a requirement to have a minimum of 25% of each trekking team First Aid qualified. This requirement was fulfilled by the Trek Team Leader and the nominated medical lead for the team, who completed a Level 2 First Aid Course at HMS Excellent prior to the exercise. All personnel were in date for RNFT and medically fit at the time of the exercise. Additionally, the High Risk and Remote panel stipulated that all participants were to have a dental check-up within 3 months of expedition departure.
A pre-deployment health brief was delivered to all team leaders at Headley Court prior to departure. This brief included the expedition immunisation policy, MEDEVAC procedure and identification and treatment of Cold Injury, Hypothermia andHeat Related Illness. Additionally, the risks associated with trekking at altitude were discussed at length, which included measures for prevention, recognition and treatment of High Altitude Illness.
THE TREK Kathmandu to Beni. Our journey to Kathmandu went to plan and on arrival, we were met by a Far Frontiers representative and quickly transported to the Hotel Marshyangdi in the Thamel region of Kathmandu. The next two days consisted of a mandatory visit to the British Embassy, a little sight-seeing and general re-alignment of the time displaced by jet-lag.
On the morning of Day 3 we met our Sirdar, and boarded a minibus bound first for Pokhara, then onwards to Beni where we would spend the night. The Sirdar is the one person who co-ordinates the support staff and controls the execution of the trek. He selects the Guides, Cooks and Porters for the trek over which he has ultimate authority. He is the single point of contact for any issues within the team.
There is a strict order of hierarchy within the support staff, and it was important that we as clients respected this rank structure. After the Sirdar, the Sherpas are next in the pecking order, followed by the head Cook and beneath him, the four Cook Boys. The Porters form the largest portion of manpower at the base of the pyramid. It is possible to transcend the levels of hierarchy; a Porter may work his way up to become a Guide, or even Sirdar; though this is likely to take many years.
Darbang to Doban. The journey from Kathmandu to Beni had been long, hot and uncomfortable, and the journey from Beni to Darbangeven more unpleasant. Fortunately though, this leg of the journey only lasted three hours. We dismounted in Darbang and ate lunch before commencing our trek; the first stage of which took us to a riverside camp site. We made the most of the opportunity the river presented, cooling off with a swim and rinsing the dust from our clothes.
The following morning we were woken with tea brought to the tent at 0600; a bowl of washing water delivered at 0610; bags packed and out of the tents by 0630; breakfast at 0645; departure and on the trail by 0730. This was to become our standard routine for the remainder of the trek (with the exception of the washing water which was retired by request after the temperature dropped below zero!).
Three more days of trekking took us through lush, forested sections of the trail, passing through a number of farming communities, receiving a warm welcomeand the traditional “Namaste” greeting from all. With overnight camps at Jukepani, Bagar and Doban the altitude increased steadily and the climate became cooler.
Doban to Italian Base Camp. Leaving Doban behind us, we continued trekking through dense cool forest, occasionally getting glimpses of the snow-capped mountains towards which we were heading. Climbing steadily we reached our next camp site at Sallaghari. At an altitude of 3100 metres the reduced oxygen levels were noticeable; movement was slower and breathlessness occurred rapidly with any moderate exertion. This would be the start of our acquaintance with life at altitude.
The next morning we emerged from the forest and continued to climb steadily along the base of a steep sided valley. The terrain here is in a constant state of flux: landslides, storms and glacial melt water all contribute to the instability of the landscape. Selecting an appropriate trail through the continually changing environment was a skill that rested with our two Sherpa guides. Humble and understated, these two men were an endless source of knowledge and information about the environment through which we were travelling.
We were welcomed to Italian Base Camp by the two members of the medical research teamstationed here to conduct testing and research on the trekking teams as they passed through. Prior to departure from the UK, all team members had attended sessions at Leeds Beckett University in order to establish individual baseline data. This included provision of blood samples, normal resting heart rate data, blood pressure readings and echocardiogram recordings. These tests were then repeated at Italian Base Camp (3600m), Dhaulagiri Base Camp (4700m) and Hidden Valley (5100m).
In addition to the tests carried out at the 3 research stations we were also required to keep a daily record of our resting heart rate, oxygen saturation levels, perceived breathlessness and perceived exertion. This data was recorded in individual booklets and returned to Leeds Beckett University on completion of the expedition.
Throughout our first night at Italian Base Camp we were reminded of our location by the periodic rumbling of nearby avalanches. Every so often, moments after the rumbling had ceased, our tents would be peppered with the spindrift kicked up by the avalanche. Whilst we never felt we were in any danger, our tents were always located well away from run-out zones. This was a tangible reminder that we were in an area where avalanche was a very real risk.
The following day was reserved for acclimatisation. We made use of this free day by trekking up a nearby ridge which formed part of the Dhaulagiri massif. As we climbed to an elevation of 4000m, all of us were noticeably affected by the altitude, but our efforts were rewarded with some spectacular views of Tsaurabong and the ridges of Manapathi.
Italian Base Camp to Hidden Valley. The trek out of Italian Base Camp quickly became steep with exposed sections; the trail underfoot was loose and unstable and we were flanked by steep-sided inclines. These factors all served to focus our attention and it was with some relief that we finally ascended onto the Chhongardan Glacier. As we approached Japanese Base Camp we witnessed a large chunk of the Dhaulagiri West Icefall break away and crash into the glacier below.
The glacier was to become our home for the next three days; Japanese and Dhaulagiri Base Camps are simply the parts of the glacier that happen to be gouging its way over a given geographical location at that time. Our tents were pitched on the areas with the smallest rocks which, in turn, rested on the deep river of glacial ice. The nights had now become extremely cold and we were required to take measures to prevent our drinking water from freezing.
The effects of altitude had now taken a firm hold with some members of the team suffering from unpleasant headaches, loss of co-ordination and interrupted sleep. A further acclimatisation day at Dhaulagiri Base Camp saw an improvement in the team, though the biting wind, sub-zero temperature and lack of oxygen had a noticeable impact on the overall morale.
After three days of living on the glacier it was a relief to leave Dhaulagiri Base Camp and commence our trek towards the highest point of the Dhaulagiri Circuit, French Pass. However, at nearly 5400m, climbing over this pass would prove to be more testing than we initially expected. From the outset the trail climbed relentlessly, causing us to become fatigued very quickly and making progress extremely slow. The Sirdar had foreseen this, and we now understood why he had insisted on the 0500 departure from Dhaulagiri Base Camp.
We reached the top of French Pass in the morning sunshine and dwelled for a short time, looking back across the valley to the dramatic bulk of Dhaulagiri and glistening faces of Tukuche. Despite the breath-taking backdrop, the condition of those suffering most from the altitude was not improving so we commenced our descent into the Hidden Valley.
On arrival we were greeted by two more members of the medical research team; Lt Cdr Phyl Scott and Lt Emma Vincent. They had been joined by Maj David Holdsworth who had trekked up from Dhaulagiri Base Camp in order to carry out echocardiograms on us as soon as we arrived in camp. After a period of testing, sampling and monitoring we were free to retreat to our tents for some rest.
The following day was scheduled as a rest day; the wind had subsided and the sun had come out, so we had breakfast ‘al fresco’ then the day was at our disposal. Some took the opportunity to catch up ona bit of laundry whilst two members of the team took a short trek up one of the many ridges that surrounded Hidden Valley.
One member of the team however, was feeling the adverse effects of altitude, and took the opportunity to rest, remaining in camp under the watchful eye of our medical lead, periodically monitoring his Lake Louise Score (LLS). The LLS is a quick and effective method of evaluating the symptoms of Acute Mountain Sickness (AMS). Taking a number of readings over a period of time can clearly indicate if a casualty’s condition is improving or deteriorating. The LLS for this individual had increased during the day, indicating worsening symptoms. A decision was then made to administer Diamox, a drug used to reduce the symptoms of AMS.
Despite the medication, our patient’s condition deteriorated further and by 0500, it had become clear that an attempt to trek out of Hidden Valley may cause him to deteriorate further and would possibly place him in a more exposed and remote location. Following a meeting with the Research Team and the Sirdar, the Trek Team Leader made the difficult decision to evacuate the patient by helicopter. By 1100, our man had been successfully air liftedfrom Hidden Valley and transported to Kathmandu where he made a full recovery.
Hidden Valley to Marpha. Our trek out of Hidden Valley was a long one. Initially climbing steadily, we reached the top of Dhampus Pass in the sunshine and were treated to an expansive view of the Annapurna range, flanked by Tukuche on the right and Dhampus Peak to the left. Our timing couldn’t have been better; ten minutes later, the cloud rolled in and obscured all views for the remainder of the day.
A series of undulations kept us at an elevated altitude for a number of hours as we negotiated slippery scree slopes and exposed snow fields. The going was hard and it was a relief for all of us as we finally started a steep descent towards our overnight stop at Alu Bari. As we walked into camp, the wind picked up and the heavens opened. Fortunately, our team of porters had yet again, employed their impressive efficiency and our tents were already pitched, allowing us to shelter until the medley of rain, sleet and snow had passed.
The mood was distinctly different in camp the next morning. This was to be our last day of trekking and suddenly seeing the end come into focus gave us all conflicting emotions. The sun shone as we descended the steep trail, first through thickets of juniper and then into a well-established forest as the altitude decreased; many of the porters gathered sprigs of juniper to burn as incense within their homes.
Arriving in Marpha, we acknowledged the completion of our trek with a sample of the ‘famous’ Marpha Apple Brandy. One small glass is more than sufficient for sampling purposes! Nights under canvass were now over and our accommodation here would be in the Hotel Royal Snow Leopard which was a basic, but functional lodge. It was here that we bade farewell to our staunch and resolute team of guides, cooks and porters. We enjoyed a glass of beer and we tipped them well; they had earned every penny.
The next morning we were picked up in a 4x4 and transported along 75km of dirt track back to Beni which took us four hours. We swapped the 4x4 for a minibus in Beni and rode the rest of the way to Pokhara in comparative luxury. The following day saw us complete our journey back to Kathmandu where we spent two more nights before commencing our return journey to the UK.
SUMMARY This exercise provided all personnel involved with physical, mental and psychological challenges that are rarely encountered in the workplace. The team was operating in an unfamiliar environment which was uncomfortable, cold, exposed and unforgiving. The challenges that are normally associated with hill walking and trekking became intensified by the additional demands of functioning at high altitude; there were times when even sleeping seemed like hard work.
The case of AMS at Hidden Valley was dealt with appropriately as we had acquired a good understanding of the causes, symptoms and effects of AMS, leading to early identification and appropriate treatment. We utilised the expertise and experience at our disposal, drawing medical advice from the research team and strategic advice from our Sirdar before making a decision to evacuate our casualty.
Throughout the expedition, the team faced and overcame a variety of challenges which presented valuable experience for all. This, along with interaction with the local people and the strong bond that developed within the team, made this a rewarding expedition and a successful conclusion to the exercise.
WO1 D Scott
