A Doctor In The Himalayas

by Dan Jones

“And if he should stop breathing during the anaesthetic I can always use artificial respiration.”

“One white tablet a day, one green tablet a day, one yellow tablet and one red capsule every two days.”

“If anyone is ill before we get the drugs through the Nepalese Customs, then he will have to practise yogi because I can’t break the seals.”

Such thoughts were almost the hmit of my medical activities during the first part of the Journey; my medical talents were allowed to he dormant apart from ensuring that everyone had antimalarial drugs, and treating the odd sahib for dysentery.  Perhaps the highlight of this stage was an encounter with the Indian Customs who eventually succeeded in explaining to me that my £170 cine camera was surely worth about .£15 second­hand (otherwise they were sorry they would have to impound it).  My pockets at this time were bulging with Dangerous Drugs which I had been advised to conceal at all costs, otherwise I should have been delayed several weeks with customs formahties.

Once clear of Katmandu and on the march, there seemed to be more scope for being a doctor.  At any rate the equipment was available, two huge boxes of it, ten to twenty pounds heavier than any other load and usually perched precariously on the backs of the most fragile looking porters.  If anything happened at the front of the caravan, I would be fairly certain of a long period in which to consider my treatment before the wherewithall caught up with me.

At this stage we ourselves needed very little doctoring.  It was the porters and local inhabitants who took up most of the time.  Surgery was set up in the evening when we had found a camp site.  Murari would act as interpreter, nurse and often as dispenser.  He seemed to enjoy his office thoroughly.  However, not even he could do much to help me solve the problem of where in the boxes were the particular drugs I needed, nor the even more difficult problem of how to replace them all and shut the box lids afterwards.  This was bad enough at night but was much more hectic in the morning when the whole expedition wanted to get on the move.

Evening surgery was more like a circus than a consultation.  What seemed to be the total population of the local village would encircle us and one by one step into the ring to display their ailments.  First it would be the men, then the children and then, with a little more hesitation, the women.  However, there was no false modesty and they all allowed me to prod their bellies and listen to their chests with less embarrassment than many western patients.

The nature of the illnesses varied greatly.  Many of them were very real; coughs with blood stained sputum — almost certainly tuberculous; chronic diarrhoea — probably amoebid dysentery; skin eruptions and burns, made septic by contact with dirt; a child with discharging ears.  Eye complaints were some of the most common — and the saddest.  There was little one could do to alleviate the chronic infections which had, in many cases, been going on for years.  Old folks with the most advanced cataracts and corneal ulcers would hobble forward for a few of the drops which they were sure would make their eyes as good as new.  When it was explained to them that we could not work miracles, they would retire into the crowd again, puzzled and sad, their eyes filled with tears.  We were honoured by a visit from the Lama of the village.  Did I think his spectacles were correct?  He too had advanced cataracts and could probably see little, nevertheless he had the only spectacles we saw outside Katmandu !  One small child was acutely ill — probably cholera — pale and dehydrated from diarrhoea and vomiting.  She was almost moribund and seemed unlikely to live more than twenty-four to thirty-six hours.  Without a great deal of hope, I gave her two injections of an anti-biotic before continuing on up the valley.  A month later on my return I learnt she was alive and well.

Others had weird or vague symptoms which it was impossible to fit into any diagnostic pattern — pain on getting up in the morning, pain on getting cold, pains in the oddest and most unlikely places and all responding quite miraculously to pills, especially if covered with tin foil!  The sirdah of the porters has a pain in his thigh.  Something must be given to rub on to it — good relations must be kept at all costs.  One lady had a pain which I confidentially diagnosed as angina of effort.  I had to modify this diagnosis next day when I saw her carry a sixty pound load up the mountainside.

By contrast the sahibs’ complaints were slight, straightforward and eminently treatable.  Nor were there many of them.  Dysentery was high on the list.  However, we all had it very mildly so that it could scarcely be called true bacillary dysentery.  It usually lasted two to three days, with no raised temperature, and made the sufferers feel’ groggy.’ One of us developed a more severe attack which lasted for some time and took a lot of curing, but even it was never completely incapacitating.  There were no real chest infections, perhaps because we never chmbed high enough.  One man had an irritant cough at night.  We phed him with cough mixture, but none of it seemed to work.  Sore heels, blisters and sore lips were fairly common.  One hp failed to res­pond to any of the more usual remedies and had to be treated with Gentian Violet — much to the owner’s discomfiture when facing colour photographers.

What of the effects of high altitude, sun and cold?  We all, of course, became breathless much more easily on exertion, but not to any excessive degree.  I myself have been more affected on a high alpine summit.  Several members of the party developed severe headaches at different times and these did not respond to the usual medication; time and acclimatisation seemed to be the only effective treatment.  One of us had a typical mountain-sickness episode of nausea and malaise at Camp III.  This quickly subsided on return to a lower altitude and did not recur.  We had no snow blindness or frostbite.

There remain the two casualties from the second accident; Lakpa who sustained a bad compound fracture of his left tibia, and myself who was lucky to escape with a dislocated right shoulder.  I had made arrangements for a wide variety of medical emergencies but not for the doctor to attempt to reduce his own dislocation, or to attempt to treat others.  Lakpa presented a problem.  Should his leg be put into plaster > I had no plaster shears which are essential for plaster removal.  An inexperienced hand might apply the plaster too tightly and we would not be able to remove it.  Lakpa’s leg would have to be splinted.  At any rate, we would be able to look out for infection more easily, a point which proved most important.

At the time of the accident the first problem was warmth, first aid and the relief of pain.  Since it was only a day trip we had no stores with us.  Camp I was empty of all save the tents and a little food.  Tallon set off back to Base Camp and left us lying in the sun.  He returned in excellent time with a mixed bag of medical stores and set to work to deal with Lakpa’s leg.  I was useless for anything other than advising.  Tallon had the unenvi­able task of straightening a very grotesquely bent leg and of dressing the wound and applying the light metal splints.  This he did most efficiently, although turning a delicate shade of green at one point.

Lakpa also had a large cut on his knee, another on his forehead, and numerous abrasions on other parts of his face.  The cuts should really have been sutured, but I could not manage this.  When we eventually reached base camp they were healing so well that I was unwilling to disturb them.  By the time he reached Katmandu his minor injuries were all quite healed.

My own injury, although less severe, was harder to treat as an emergency.  The golden rule with such dislocations is reduce them as soon as possible.  Tallon soaked me in Morphia and then set about trying to do this.  I gave him instructions — just how and where to pull and move the arm.  After the first attempt my arm was somewhere above my head and wouldn’t come down again.  At the time this was rather distressing though in retrospect it has its amusing side.  The normal procedure with such a disloca­tion would be to anaesthetise the patient, but I had some pretty strong views on that subject ! More Morphia and another determined attempt brought my arm down to my side, but still out of joint.  We decided to leave it where it was.

I shall not describe our journey back to Base Camp except to say that it was most excellently organised and carried out.  Once I was fit enough to move, my troubles were over for I was much more comfortable sitting or walking than I was lying.  Lakpa was, of course, unable to walk and for him the journey back to Base Camp and from thence to Katmandu must have been an extremely painful ordeal.  He was so stoical that it was extremely hard to tell when he was in pain and how severe the pain was.  I gave him Morphia initially, then Pethidine and finally only barbiturate, sleeping tablets.  If he was ever in excessive pain, he would not admit to it.  Nor did his leg respond to Penicillin by mouth, given in order to try to prevent infection.  The leg splint was removed periodically and five days after the fracture the wound looked fairly healthy.  Five days later there was infection round the wound and spreading right up the thigh.  This was most worrying and I started Penicillin by injection straight away.

This was another serious incident which had its amusing side.  Our sterilising procedure must have been quite unique.  One of the billy-cans was used.  Ang Temba would boil the syringe up in the cleanest water he could find — this always contained a liberal supply of bits of dirt, some of which would inevitably get into the syringe.  Still, it was sterile dirt so we ignored it.  I would try to get hold of the billy-can when Ang Temba was not looking but seldom succeeded.  He usually bore the billy-can towards me and before I could stop him, placed his filthy fingers around the tip of the sterile needle and handed it triumphantly to me.  The only comparable action I have seen was when he cleaned my table fork by spitting on it and wiping it on the inside of his shirt ! In spite of this, the Penicillin worked superbly and when Lakpa finally reached Katmandu there was very little infection to be seen.

At Katmandu my Himalayan doctoring finished.  Lakpa was put to bed in the American Mission Hospital and his fractured leg placed in traction.  He was to remain there for three months.  We have heard that his leg was very slow in healing, and that although now healed there is some shortening and he will have a per­manent limp.

After a very creditable but only partially successful attempt to reduce my dislocation at the Mission Hospital, I returned to England and the job was completed by open operation.  I have now a slighdy limited range of shoulder movement, with hopes of full movement later.  For me the disability was well worth the experience, but for Lakpa this cannot be so, for the hmp will hmit his ability to earn a living.

From a medical point of view, the expedition was com­paratively uneventful, except for the casualties of the second accident.  But these bring home the essential difference between Himalayan medicine and that in Europe.  Any illness or accident on the mountain will have to be treated for at least two weeks before hospital can be reached.  One doctor and a limited amount of stores cannot always ensure that the two weeks delay is of no significance, but they can do a great deal towards minimising it.  In an expedition which has had more than its share of trouble there is one slight consolation; we may have saved the hfe of one small sherpa child.