Constipation, Paraffin and other things…
the Expedition Doctor’s Notes

Rory Newman

Expedition doctoring turned out to be easier than I had feared. Most of the work and nearly all the worry took place before departure. A lot can be done to avoid problems during the trip by advising and encouraging expedition members about sensible precautions and preparations.

There are awkward decisions to be made about what to take and what to leave behind. To some extent the area and activities affect this but there are also constraints of weight, size and cost. There’s no point in taking drugs or equipment that nobody in the party is competent to use and it’s impossible to allow for every eventuality.

For the Nepal trip I took the approach that I should be equipped to treat most problems that can be treated effectively on the spot without intensive technological support. I reckoned we could improvise splints, stretchers, neck supports and the like if needed. I’m afraid that given the difficulties of communication and evacuation from the climbing expedition base-camp I considered that very major medical problems or injuries would probably be fatal in spite of treatment. Therefore I didn’t take appropriate treatments. I used the same rather nihilistic approach to equipping the trekking expedition by not giving them anything I didn’t think that they would be able to use. Apart from the appropriate medications, etc., for a party away for six weeks, I’d taken specific treatments for altitude sickness, snow blindness and frostbite.

Either those decisions were correct or we were lucky as we had what we needed except perhaps a real dynamite treatment for constipation: a problem I had not anticipated in Nepal. I’d be happy to discuss what to take and how to organise doctoring an expedition with anyone else faced with the task.

Medical problems on the trip were mostly the predictable diarrhoea, coughs, colds, minor injuries, etc. plus mild altitude sickness. The most exciting incident occurred early in the trip when a porter tried to encourage the camp fire with kerosene. The resultant explosion looked and sounded potentially disastrous and set off a ring of subsidiary fires. The porter was blown upwards and backwards but his only injury came from biting through his own bottom lip in surprise. The most serious problem encountered on the expedition was also kerosene related. Another porter, carrying a leaky container, walked all day with his shirt soaked in it while his pack rubbed. This removed most of the skin from his back – the equivalent of second-degree burn. I treated him with soothing antiseptic lotions, dressings, antibiotics and painkellers so that he was improving by the time he set off for home from base-camp wearing one of my clean shirts as I was running short of clean dressings. It was also interesting, though frustrating, to see and try to treat people in the remote villages on our return journey. It is surprising how far you can get with sign language and a little bit of interpretation. No real medical help is available in these villages as medical care is two or three day’s walk away. Too far to bother for minor problems and still too far for seriously ill patients.

My general impressions of Nepal are that it is much the friendliest country I’ve visited and the place I felt safer there wandering about on my own in the cities, as well as the wilderness, than anywhere else. As with any ‘developing’ country, the real problems come where western and local cultures are juxtaposed.

The people in the more remote villages live a fairly hard life of subsistence farming but the older ones and the children seem satisfied and cheerful. The younger adults wonder what they are missing and dream of the supposed delights of Kathmandu. On the other hand, small children can wander about the countryside unmolested and without fear, so perhaps civilisation isn’t all it’s cracked up to be.

I ended up doing less medicine and more climbing than I’d expected and so enjoyed myself very much. If I get another chance I would certainly go back.