Adventure in Nepal: Team CURTAIN (Current Understanding of Relevant Trends in Altitude Illness in Nepal)

CURTAIN team: Elan Small, Laurel Gardner, Shaswat Kunwar, Nishant Joshi, Mary Starrs, Lakota Cleaver, Andrew Leamon, Kate Votta, Tejaswi Adhikari, Hillary Baker, Nate Barott, William Bunzel, Jerome Rogich, Rony Maharjan, James Marvel

From late March through May of 2022, a group of intrepid Emergency Medicine physicians traveled to Nepal and joined forces with exceptional Nepali physicians to embark on project CURTAIN (Current Understanding of Relevant Trends in Altitude Illness in Nepal). Countless momos later, the team returned to the United States with full hearts, and a ton of data looking at acute mountain sickness in the Khumbu and Manang regions. The project was a prospective survey study aiming to re-establish acute mountain sickness (AMS) point-prevalence, and understand the relationship between COVID and AMS as well as oral contraceptive use and AMS. The project involved four teams of 2-3 American physicians paired with a Nepali counterpart, each collecting data for 3 weeks, yielding a total of roughly 6 weeks of data at each location. This is their story.

Khumbu Team

April

After meeting as a full team, the Khumbu group said good-bye to their Manang counterparts and headed off for the journey to the infamous Lukla airport. The team consisted of Stanford Emergency Medicine (EM) residents Elan Small (PGY-4) and Mary Starrs (PGY-3) as well as Yale University EM resident Lakota Cleaver (PGY-2). The team soon met up with their Nepali compatriot Shaswat Kunwar (EM House Officer) for the five-day trek to the final destination of Lobuche (16,207 feet). The trek was breathtaking, filled with brilliant stupas, rugged peak backdrops, and lots of elevation gain. The team stopped by inspiring health outposts along the way, including meeting legendary Khumbu physician Dr. Abhyu Ghimire of the Mountain Medical Institute in Namche, as well as visiting the Pheriche Himalayan Rescue Association and Gorak Shep health outposts. These incredible physicians provide an impressive array of services to both local and trekker populations, on-call 24-hours a day.

Upon reaching Lobuche, the team unpacked the study materials (pens and printed surveys), shared tea and introductions with the local tea house owners led by Shaswat and embarked on the project at hand. Arriving with 500 copies, the team passed out over 400 in the first three days, demonstrating a clear supply-demand mismatch. To the Khumbu group, this presented a serious problem. To mountaineering legend Garrett Madison (who kindly filled out a survey), this was a piece of cake. The obvious solution: he’d print more copies and have them helicoptered to Everest Base Camp (EBC) with the next food shipment. Thank you, Garett Madison!

Clockwise: Elan overjoyed at an abundance of data. Shaswat recruiting individuals for the study. Mary hard at work with data entry. Lakota entering data with Nuptse in the background checking her work.

Over the course of the next three weeks, the team collected over 800 completed surveys, connecting with an amazing group of both local and visiting people. They discussed altitude medicine with individuals from around the world. The team also had the opportunity to summit Lobuche East and experience how 20,000 feet of elevation affects cognition. The group interacted with impressive Everest climbing groups, notably the first all-black team to summit Everest, team Full Circle. Congratulations team! You are an inspiration! After an amazing three weeks, the April group was greeted by an enthusiastic new team to carry the torch.

Left to right: Teju, Nima (our amazing guide!), Lakota, Mary, Elan, Laurel,
Hilary, Nate. The Khumbu groups meet in Lobuje!

May

Hailing from all over the US (and Nepal), the May team convened in Kathmandu. There was an obvious relief finally being in Nepal, given the fear that COVID might halt what was, for many of them, the first big trip since the pandemic started. Destined for Lobuje via the Everest Base Camp route were Stanford EM Laurel Gardner (PGY-4), Orange Park EM Hillary Baker (PGY-3) and Nate Barott (MS-1) as well as Tejaswi Adhikari (Nepali EM House Officer). The May team was blessed with good weather for the infamous Kathmandu to Lukla flight and embarked sans delay.

When the team finally arrived at Lobuje (the 2nd to last stop on the trek to EBC) to take over for the April team, they were all in awe of the incredible beauty they’d get to live and work in for the next three weeks. After a hello and debrief, they embarked on their portion of the research, quickly blown away by the hikers’ willingness to participate in the study and by the incredible stories they shared. From the youngest they encountered (a 4-year old trekking with her parents), to the oldest (several couples in their 70’s living their best life); from seasoned mountaineers (the man who now holds the record for most summits by a foreigner), to the most ambitious (the youngest American woman to summit Everest), all graciously agreed to participate in the research.

Right to left: Panorama Lodge owner (and so much more) Migma, Nate, Laurel, Hilary, Migma’s mother, Teju.

In addition to these adventures, the team was welcomed into the Khumbu community by an incredible group of locals. Time and again they were treated with hospitality and compassion, from the renowned Oxygen tea house owner who came to find them after a particularly hard hike ran long in undesirable weather, to the EBC Guest House lodge owners who regularly made the team seabuckthorn juice and cooked a goodbye breakfast. From the cook who let expert chef Laurel Gardner demonstrate how to make a quesadilla on Cinco De Mayo (per Dr. Gardner, 5/10 execution if we’re being honest), to the most incredible host from Panorama Lodge in Namche who greeted the team with a warm smile and hot towels and tea after every hike. Each of them took time to share their home and culture and for that team CURTAIN are immensely grateful.

Manang Team

April

While their fearless counterparts were stuck in Kathmandu airport waiting for their Lukla flight, the April Manang group set out Jeep-style towards the Annapurna Circuit for an 8-hour drive to the mountain start point of Syange. Over the next 5 days the team, consisting of Kate Votta (Mount Sinai PGY-3) and Andrew Leamon (International EM WSU/Henry Ford Fellow), trekked for nearly 50 miles from 3,500 feet up to 11,500 feet to the mountain town of Manang. Fueled by Dal Bhat, noodle soup, and the ever-present momos, the team dove into the journey; swimming in hot springs, befriending local tea-house pets (and stray dogs), and even catching a stunning sunrise over Manaslu from the roof of their lodgings.

Left to right: Andrew, Kate and Nishant happy campers at Ice Lake!

Upon arriving in Manang exhausted and exhilarated, they quickly took up lodgings in one of the 17 tea houses and started enrolling other trekkers in the study. Joined by Nepali doctor Nishant Joshi (Nepali EM House Officer), the team got to know everyone in town, from the mountaineers reminiscing on Everest in the 90s to the USA high school students there for a (rather extreme) class trip. As a town where most trekkers spend an extra night to acclimatize, Manang has many well-traveled day hikes, a cultural museum, and even a movie theater, though unfortunately only open in late summer. The team got to go horseback riding (no, there were no stirrups on the saddles), and participate in an archery festival that lasted the entire first week (they will not be hunting their own food anytime soon). There was also a Himalayan Rescue Association outpost with a team of wonderful doctors on staff, giving altitude lectures daily and letting the team check that yes, their oxygen saturations still hadn’t climbed above 90%. Many of the tea house owners invited the group to dinner, and they even had dinner with a world-famous snow leopard photographer with a Disney Conservation award who hikes out to take photos in his off time from running a tea house. In between meeting trekkers and finding a way to print more surveys from the local school (thankfully not requiring an airdrop), the group hiked out to Tilicho Lake (16,100 feet), Ice Lake (15,200 feet), and capped the trip with a journey over Thorong-La Pass (17,800 feet). Getting to spend a few weeks living in a town with so many interesting people and traditions was far and away the highlight of an incredible adventure.

May

The second group, consisting of William Bunzel (Wilderness Medicine Fellow at UCSF Fresno) and Jerome Rogich (Emergency Medical Services Fellow at Stanford University), traced the path of the April group and expanded on many of the relationships the April group established in Manang. After an equally adventurous jeep-ride to Syange, they completed the trek in five days, stopping to enjoy the views of the Annapurnas, Manslu and appreciating the dramatic changes in flora and fauna during the ascent.

They soon met up with Nishant, who wasted no time introducing them to the local innkeepers in town, the hiking trails, cuisine and where to get the best Wi-Fi. They also made sure to check in on a remote gomba (monastery), to reassess the nun who had sprained her ankle the month prior. The April Manang team had placed her ankle in a plaster slab- they found her mobile and able to complete her activities of daily living!

Left to right: Jerome, William and Nishant enjoying views of Tilicho Lake.

The time in Manang seemed to pass too quickly and after an incredible experience, the May group split up for the trip back. Will met up with his wife in Kathmandu and completed the 50-mile journey for a second time before crossing over the pass. Jerome met up with a group of Germans and Dutch, crossed the Thorong-La Pass, and had multiple reunions with many of the trekkers he met during his time in Manang, in the lake-side town of Pokhara. Nishant’s friends from medical school met him in Manang where they also crossed the pass before settling back in Kathmandu to take their American Medical Boards.

And just like that, project CURTAIN was a wrap! Above all, the CURTAIN team would like to sincerely thank the folks who made this possible- the gracious tea house owners, all the heroically hardworking porters, guides, and medical staff who make it possible to share such a special place with the world, and to all the individuals that were willing to partake in the study.