The Pilgrim at High Altitude

The fall issue of High Altitude Medicine & Biology, the official journal of the International Society for Mountain Medicine, is opened with an insightful editorial by Buddha Basnyat, M.D., a long-time friend who resides in Kathmandu, Nepal. Entitled “The Pilgrim at Altitude,” the discussion focuses on the observation that many pilgrims ascending mountains for religious purposes are stricken with mountain sickness, and may die without fanfare, in contrast to highly-publicized incidents among recreational and professional mountain climbers, such as those attempting to summit Mt. Everest.

As commented upon by Basnyat, thousands of religious pilgrims seek to visit the abode of the gods, often at altitudes above 4300 meters. If they become ill with acute mountain sickness, they may not turn back, and so develop high altitude pulmonary and/or cerebral edema. Worse still, others might ascend by helicopter, essentially eliminating any chance for acclimatization to the high altitude.

Unfortunately, scant or no records are kept, so the true incidence of illness is unknown. Undoubtedly, many thousands of visitors to Mount Kailash at 6714 meters have been struck down or even succumbed to high altitude illness. Victims are often elders, and may be misdiagnosed with altitude illness. Some may even feel privileged to die in the shadows of such a holy place.

Doctors of the Himalayan Rescue Association are doing what they can to be available during predictable congregations in Nepal (such as at the Gosainkunda lakeside north of Kathmandu during the August full-moon gathering), but it is impossible to be everywhere in the Himalayas, so education efforts are critical.

I highly recommend High Altitude Medicine & Biology to all physicians and researchers interested in the physiology of high altitude. In this same issue (Volume 7, Number 3, 2006), there is a wealth of fascinating information, including a case report by Susi Kreimler and coauthors about the successful treatment of severe acute mountain sickness and apparent correction of excessive pulmonary hypertension with dexamethasone in a young girl. One case is not proof of cause and effect, but it is intriguing to hypothesize a benefit, which hopefully can be corroborated (or disproven) in the future.

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