Something startles you awake.

“What was that?”

You slowly start to brush away the mental cobwebs.

There is a tapping on your tent. That must be what woke you up.

You squint at your watch through crusty eyes. It’s after midnight.

As you push through the gray in your mind, you begin to piece together what is going on.

Through the haze you remember—it’s summit night.

You slowly begin dressing, putting on all your layers.

Many thoughts and emotions are now racing through you.

“Can I make it?”

“Is it worth it?”

“Should I just go back to sleep?”

“Why do I feel so awful?”

kilimanjaro night
You hear voices outside the tent. Suddenly you are fully awake. You are now acutely aware what is going on. Your pace quickens as you quickly pull on the rest of your layers. You step out of the tent into the dark. It is so dark. And cold.

You pop your head back into the tent and grab your headlamp. Slinging your daypack over your shoulder, you stumble off toward the mess tent to choke down some food and coffee.

The wind is blowing, not hard, but enough to find every exposed inch of skin. It blows down your neck and chills you to the bone.

Before you know it, you are walking, slowly. “Pole, Pole” the guide reiterates as you plod along.

The moment has finally arrived. The moment you have been training for. Will you make it?

This is where most people fail. This is where altitude sickness can get you. So how do you prepare for it? How do you make sure you are not one of the thousands annually that do not make the summit. The best way to accomplish this is to be fully prepared.

Choosing an Operator

First of all, to begin your preparation it’s essential to pick the right Kilimanjaro operator. For one thing, choosing a budget operator may save a few dollars on your climb. But it can end up costing more in evacuation fees, doctor and hospital fees or possibly worse. For this reason, when choosing an operator, choose one that has a track record of safety.

Safety

How do you know how safe an operator is? Do your research, If an operator doesn’t focus on safety then you won’t find much information on their website. You should also read forums on websites like TripAdvisor. If the company is upfront with their safety record, then odds are they focus on safety. At Peak Planet, your safety is our number one priority. Consequently, making the summit is much more difficult if you don’t climb safely. We place a high importance on your safety. With this in mind, we perform daily health checks on the mountain.

Health Checks

Let’s get down to the nuts and bolts of what a health check is. Our guides don’t just ask you questions and leave it at that. They go through an entire evaluation of how you are feeling every night. Furthermore, these test results are logged and compare each night.

We start by:

  • Checking your temperature: We do this with an infrared or armpit thermometer.
  • Check your blood oxygen saturation: We use a pulse oximeter to monitor your blood oxygen saturation.
  • Take a heart rate reading: We check your pulse.
  • Check your blood pressure: We check this by the wrist. Of note: 70% of people have a blood pressure spike during the Kilimanjaro climb. This is normal. Within two days the blood pressure should drop back down to normal levels.
  • Listen to your lungs: We use a Stethoscope to listen to fluid build up in the lungs. This is known as for pulmonary edema. Read more below. Our guides carry medication to pull the fluid from the lungs.

Our First Aid Kit

In order to make your climb successful, our guides bring along a first aid kit on every climb. As a result, they will have everything they need to make sure your climb is safe. Below is a list of the items we carry on our climbs.

Equipment

  • Pulse Oximeter
  • Sphygmomanometer (blood pressure monitor)
  • Digital Thermometer
  • Stethoscope
  • Paramedic Sheers
  • Medical Gloves
  • Oxygen Bottle and mask
  • Portable Altitude Chamber (Northern Circuit Treks)

Other

  • Rolled Gauze
  • Gauze bandages
  • First-aid cleansing pads
  • Butterfly strips
  • Iodine

Medication

  • Diamox
  • Dexamethasone
  • Furosemide or Bumetanide
  • Mannitol
  • Phenergan
  • Compazine
  • Imodium
  • Tetracycline
  • Amoxicillin
  • Ciprofloxacin
  • Antibiotic Ointment
  • Antiseptic Cream
  • Paracetamol with Codeine
  • Rehydration Salt
  • Glucose Tabs

Additional Health Tips

Likewise, if you are having any stomach related illnesses such as nausea and/or diarrhea talk to your guide. Do not try to self-medicate. Some medication can actually make things worse or cover up symptoms that are part of a larger issue.

Imodium

For example, Imodium or Loperamide is an anti-diarrhea medication that really helps with certain types of diarrhea. Let’s say for example you have an extremely runny stool, like basically water. If you take Imodium and stop the problem, that could actually be masking a bacterial infection in the stomach or intestines. This can lead to further complications and illness.

In this scenario, it would have been better to take Cipro or another antibiotic to fight the infection. Similarly, it would also be better to hang out in the private toilet tent for a while to let your body evacuate everything. Once the antibiotic has had a chance to work, then Imodium would be okay to take so you can move along to the next camp.

Aspirin

Likewise, another medication you should not take on the mountain is Aspirin. Aspirin prevents blood from coagulating.

Diamox

To help with acclimatization we recommend you talk to your doctor about Diamox. Take the amount they prescribe. We have found that taking 125 mg at breakfast and lunch works well.

Most importantly, just talk to your guide before taking any medications.

Evacuation procedures

amref helicopter
Furthermore, if the need arises, and it doesn’t happen very often, all of our guides carry the Garmin InReach satellite communication device. It allows our guides to quickly communicate with our off-mountain staff.

Our guides are Wilderness First Responder certified. Basically, they are EMTs on the mountain. We also partner with IFREMMONT a high-altitude medical evacuation organization on developing our mountain evacuation protocols.

Most noteworthy, we also cover all of our clients with AMREF Flying Doctors Evacuation Insurance. Depending on the severity of the person’s sickness or injury we can easily contact AMREF to evacuate the injured or sick person off the mountain.

Acute Mountain Sickness (AMS)

We have posted about Acute Mountain Sickness (AMS) and the causes, symptoms, and treatments several times. It is the number one reason people come down off the mountain before they make the Summit. If you want more information on AMS, go here: https://peakplanet.com/acclimatization-how-to-summit-mount-kilimanjaro-safely-and-successfully/

A few additional illnesses that trekking at very high elevations can bring on are HAPE and HACE. Both are not very common.

High Altitude Pulmonary Edema (HAPE)

What is High Altitude Pulmonary Edema (HAPE) and how do you avoid it? HAPE is a life-threatening form of non-cardiogenic pulmonary edema, which is fluid accumulation in the lungs. This can occur in otherwise healthy mountaineers at altitudes typically above 8,200 feet. However, cases have also been reported at lower altitudes such as 4,900–8,200 feet in highly vulnerable subjects.

Studies have not been able to pinpoint what makes some people susceptible to HAPE. HAPE remains one of the major causes of death related to high-altitude exposure. There is a high mortality rate if you do not get immediate treatment.

Symptoms of HAPE (You need at least two):

  • Shortness of breath at rest
  • Cough
  • Weakness or decreased exercise performance
  • Chest tightness or congestion

In addition to: 

  • Crackles or wheezing (while breathing) in at least one lung field
  • Central blue skin color
  • Tachypnea (rapid breathing)
  • Tachycardia (rapid heart rate)

Risk factors
Individuals susceptibility to HAPE are difficult to predict. The most reliable risk factor is the previous susceptibility to HAPE. there may also be a genetic predisposition to the condition. People with sleep apnea may also be more susceptible due to irregular breathing patterns while sleeping at high altitudes.

Prevention
To prevent HAPE a person must gain elevation slowly over many days.

Treatment
The standard—and most important treatment—is to descend to a lower altitude as quickly as possible. 400-500 feet is preferred. Oxygen should also be given if possible. Symptoms tend to quickly improve with a descent. While more severe symptoms may continue for several days. Also, drug treatments are available.

Epidemiology
Studies have shown that HAPE occurs in less than 1% of climbers exposed to altitudes above 13,000 ft.

The U.S. Army has conducted tests over 30 years. They performed these studies by exposing sea-level volunteers rapidly and directly to high altitude. Of the 300 volunteers, only three had to be evacuated due to possible HAPE.

High Altitude Cerebral Edema (HACE)

Another risk climbers take is getting High Altitude Cerebral Edema (HACE). HACE  is a severe and sometimes fatal form of altitude sickness that results from capillary fluid leakage. This is due to the effects of hypoxia on the mitochondria-rich endothelial cells of the blood-brain barrier.

Symptoms include:

  • Headache
  • Loss of coordination (ataxia)
  • Weakness
  • Disorientation
  • Memory loss
  • Psychotic symptoms (hallucinations and delusions)
  • Coma

Causes
Cerebral edema can result from brain trauma or nontraumatic causes. These causes can range from ischemic stroke, cancer, or brain inflammation due to meningitis or encephalitis. But with climbing, it is due to fast travel to high altitude without proper acclimatization.

Types
Four types of cerebral edema have been identified: Vasogenic, Hydrostatic cerebral edema, Cytotoxic, and High Altitude cerebral edema.

Treatments
HACE generally occurs after a week or more at high altitude. If not treated quickly, severe cases can result in death. Immediate descent by 2,000 – 4,000 feet is a crucial life-saving measure. Medications such as dexamethasone can be prescribed for treatment in the field. Proper training in their use is required.

Therefore, anyone suffering from HACE should be evacuated to a medical facility for proper follow-up treatment.

gamow bag
Also, a Gamow bag can sometimes be used to stabilize the sufferer before transport or emergency descent. A Gamow or portable altitude chamber (PAC) is a portable Hyperbaric Chamber. It is used for the treatment of Acute Mountain Sickness. The Gamow bag simulates a descent of as much as 7,000 feet. It accomplishes this by inflating around a patient, therefore, increasing air pressure.

Finally, we can’t stress it enough, when climbing Mount Kilimanjaro it is important that you communicate with your guide. They have been trained to recognize all of the mentioned altitude-related illness. Do not hide the symptoms. It is better to come off the mountain alive, versus the alternative. The mountain isn’t going anywhere, live to make another attempt. Listen to your guide and your own body. Above all, it is our goal to have you climb as safe as possible.

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