The Himalayan Rescue Association and Musa Masala Present the Pocket-size, Wallet-friendly, Altitude Tips Card
Musa Masala is very excited to have created, along with the Himalayan Rescue Association (HRA), a new version of the altitude tips card that we have been providing to the HRA clinics since 2018.
The new version is still printed on waterproof plastic, but it’s wallet-size and folds easily. The card features the Golden Rules of Altitude as stated by the HRA. It will be available at all the HRA clinics, in Kathmandu at the local gyms and online, at the Musa store. We want to thank Julie Ramirez and Gobi Bashyal for putting the work into this new card.
Below you’ll find a couple of awesome pieces about the HRA. First, an introduction from Dr. Sanjiv Bhandari to the HRA. Second, from Dr. Nishant Joshi Njo, on how he came to work with the HRA. A special part of this is a great interview about working at Everest ER in 2024 — special for all you Everest fans. Jam Jam!
Julie Ramirez and Gobi Bashyal at the HRA office
Lakpa Sherpa, Dr. Amy Marie Drago, Ang Diku Sherpa with the new cards
the new cards
A bit about the HRA
By Dr. Sanjiv Bhandari
Dr. Sanjiv Bhandari
Himalayan Rescue Association (HRA) is a non-profit, non-political organization run by volunteers. It has been working since 1971 when it was formed to reduce casualties in the Nepal Himalayas. HRA has been working to prevent deaths from high-altitude related illness that has been afflicting the low-altitude trekkers/mountaineers as well as high-altitude residents.
HRA has run aid posts in Pheriche (4250m altitude) in the Everest region since its inception and Manang (3550m altitude) in the Annapurna region since 1981. These aid posts are open during the spring and fall season every year. HRA also runs the Mt. Everest base camp aid post known as Everest ER (5300m altitude) every spring season, since 2003, taking care of the health needs of the mountaineers and their support staff. HRA also runs shorter temporary health camps at Gosainkunda Lake in the Langtang region during the pilgrimage week when it receives almost 20,000 people.
HRA also runs awareness programs in different parts of the Kathmandu Valley just before this pilgrimage week. HRA has been giving high-altitude first-aid training to the trekking guides from time to time. HRA also coordinates with the Nepal government during any unfortunate disasters that happen in the mountains, be it a snowstorm afflicting trekkers or any aircraft mishaps.
Thank you, Dr. Sanjiv Bhandari.
*****
For the 2025 climbing season, here is our interview with Dr. Nishant Joshi Njo on working with the HRA in its remote outposts, including his spring 2024 stint at the Everest ER, the clinic at Mt. Everest Base Camp. Nishant was the medical director for our climbing competition in 2023 provided by the HRA. He is a great friend of Musa Masala and a lover of the mountains.
Everest ER Interview with Dr. Nishant Joshi Njo
Musa: Please share a bit about yourself, how you like the outdoors, and how you got into wilderness medicine.
Dr. Joshi Njo: I come from the far west region of Nepal, where traveling to my village often involves long treks and staying in various places along the way. These experiences sparked my love for the outdoors at a young age. Growing up, I was very passionate about sports, and school became a means to achieve good grades so I could keep playing.
Even after joining medicine, my passion for the outdoors remained, and I spent holidays trekking to less touristy, more remote areas with friends. During these trips and my rural medical school postings, I was exposed to how healthcare is delivered in austere environments. It was then that I realized most healthcare outside Nepal’s major cities falls under the umbrella of wilderness medicine. This made me recognize the need for specialized healthcare in these regions, and that’s what inspired me to pursue wilderness medicine as a career.
Musa: What was it like working at Pheriche and any other HRA clinic?
Dr. Joshi Njo: After graduating from medical school in Nepal, I worked as a medical officer in the busy emergency room at Patan Hospital for nearly 10 months. Following that, I had the opportunity to work as a research assistant for Stanford CURTAIN research in Manang for two months, where I became familiar with the works of the Himalayan Rescue Association (HRA). This experience sparked my interest in joining the HRA, and when applications opened for Everest ER, I applied.
However, I was informed that before working at Everest ER, I needed experience in Pherice or Manang. I then worked in Pherice, a village at over 4,300 meters on the way to Everest Base Camp. It’s one of the busiest HRA clinics, primarily dealing with altitude-related, gastrointestinal illnesses and other illnesses among locals and trekkers. The clinic provides near-free treatment to local Nepalese while charging international trekkers, which allows it to operate sustainably.
My time at Pherice was incredibly fulfilling. I had the privilege of treating many patients, including those with life-threatening altitude illnesses such as HAPE and HACE. Knowing that our care stood between life and death for these patients was an immensely rewarding experience as a junior doctor working in the Himalayas. Moreover, we also worked with international doctors in those clinics, which provided a lot of insights and learning from the experienced global scenarios. One of the duty in HRA clinics would also be giving lectures on altitude related illness and other major health issues in the region to trekkers from all around the world, which helps us understand global scenarios and provides the growth to present your knowledge among diverse group of people.
Musa: Would you share an overview of the spring season? Patient types, climber guide, and porter illnesses, effectiveness of therapies? How compliant are the patients?
Dr. Joshi Njo: In the spring of 2024 at Everest ER, we treated 645 new patients, excluding follow-ups. Of these, 537 were Nepalese, and 108 were foreigners, with the fees from the foreigners supporting free treatment for the locals. Early in the season, we saw mostly minor traumas and gastrointestinal illnesses due to base camp construction in porters and Nepalese staff as they were preparing the base camp for climbers who were yet to arrive. Later, as climbers moved to higher altitudes, we treated more serious cases like HAPE, HACE, and severe frostbite.
Many of the Nepalese patients were porters, guides, and kitchen staff. The climbers, although better prepared, often required care at higher camps. A tough part of the job was advising climbers to descend due to health risks, which sometimes meant ending their expedition. Fortunately, most understood when we emphasized the importance of survival over summiting, though we did encounter resistance at times. We were able to treat and stabilize every patient that walked in that door with whatever that was available and that was effective treatment for the area we were treating the patient.
Musa: Do guided clients present a difficult patient care situation with their summit fever and cost/time of their tourism?
Dr. Joshi Njo: There were instances at Everest ER where patients sought answers for complex conditions requiring extensive investigations, which we couldn’t provide in a remote setting. This created a dilemma, but most patients, after we clearly explained the limitations and the pros and cons of their situation, complied with our recommendations despite initial resistance.
Greg, a seasoned colleague, was instrumental in these situations. His clear and direct communication helped patients understand the gravity of their condition. I learned a great deal from his approach, especially when we had to make tough calls like advising climbers to end their expeditions. While these conversations were difficult, we emphasized the importance of choosing life over risking it for the summit. Thankfully, our clear communication meant we never had a case where someone ignored our advice.
Musa: Would you share some fun things you did during personal time?
Dr. Joshi Njo: Living in isolation for two and a half months during each Everest ER season means it’s important to find ways to have fun and stay engaged. Personally, I made the most of my time by trekking to Kalapathar, Pumori High Camp, and exploring the surrounding areas. One of my colleagues, Shreyashi, trained with the Sherpas to learn basic climbing techniques with crampons and practiced on the nearby glacier. These activities helped keep the team energized and motivated throughout the season.
Aside from work, we made sure to enjoy the unique experiences Everest Base Camp had to offer. We were often invited to different camps for lunch, dinner, or coffee, allowing us to try new food and enjoy the luxurious setup of the base camp. Additionally, we participated in religious Poojas, where the Sherpa community worships and seeks protection from the mountain god before the climbing season. These events were both spiritually meaningful and full of fun, ending with dancing alongside the Sherpas.
One memorable highlight was when Greg and I participated in the Everest Marathon, the world’s highest marathon. While it was a fun experience to remember, my legs would never be able to forgive me!
Musa: How effective do you think the clinic is?
Dr. Joshi Njo: I believe Everest ER is highly effective in fulfilling its intended role. It excels at stabilizing patients in need of rescue and evacuation, treating life-threatening altitude-related conditions, providing pain relief, and addressing fractures and trauma. Additionally, it serves as a center for managing non-life-threatening but debilitating conditions like cough, infections, minor wounds and abscesses, snow blindness, etc.
That said, there’s always room for improvement. For instance, integrating equipment that can withstand the cold climate, like an AED, would enhance its capabilities. While it’s already doing an excellent job, especially considering the challenging environment, there’s potential for further innovations to improve care
Musa: What are the different patient presentations between Pheriche and Everest ER?
Dr. Joshi Njo: The patient demographics between Pheriche and Everest ER differ largely due to their locations. Pheriche is a village that caters to both trekkers and the local community, while Everest ER is located at Everest Base Camp, where the population primarily consists of climbers and the support teams—Sherpas, kitchen staff, and guides—who help them.
Pheriche tends to see more trekkers, while Everest ER mainly treats climbers. Although both places deal with altitude-related illnesses like HAPE and HACE, trekkers in Pheriche appear more vulnerable since climbers at Everest Base Camp are often better prepared with designated travel and acclimatization plans. Additionally, Pheriche sees a lot of local porters, who are more prone to altitude illnesses due to the fast pace they maintain to earn more, making them more susceptible to conditions like HAPE and HACE. In contrast, the Sherpas and climbing guides at Everest Base Camp tend to be more acclimatized and aware of altitude risks.
In terms of severity, Everest ER handles more serious trauma cases and frostbites, which often bypass Pheriche as patients are usually flown directly to Kathmandu. Everest ER also sees a higher likelihood of severe injuries, given the climbing activities at higher altitudes.
Ultimately, Pheriche serves more local and trekking populations, while Everest ER focuses on climbers and short-term visitors at base camp
Musa: Do you want to go back?
Dr. Joshi Njo: My experience at Everest ER and in the mountains is admittedly biased because I’ve always had a deep love for the mountains. I’ve constantly found reasons to work and stay close to them, so without a doubt, I would go back. Now that I understand the culture and have firsthand experience, it’s not only an incredible escape for me but also an opportunity to make a tangible impact on people’s lives while continuing to learn and explore. The mountains offer a unique environment where I can combine my passion for medicine with my love for nature.
I’ve always lived by the saying, ‘The mountains are calling, and I must go,’ and I truly believe that. If given the opportunity, I’d return to Everest ER. While it’s a significant commitment—volunteering almost three months of unpaid time—it’s one I would gladly take on again whenever the time and circumstances allow. The experience is rewarding on so many levels, both personally and professionally.
Dr. Nishant Joshi Njo
Musa: Any thoughts on the experience as a whole?
Dr. Joshi Njo: Working as a junior doctor from Nepal allowed me to engage with global health scenarios treating patients from all over the world. It is also a great learning experience working alongside experienced physicians like Greg in Everest ER and Luke and Renata in Pheriche. This exposure was invaluable, as it provided me with insights into global health practices and enriched my professional development. I felt a sense of gratitude for the opportunity to contribute to patient care and make a meaningful impact on their lives.
In an urban setting, junior doctors often feel relegated to paperwork and minor tasks, leading to a sense of undervaluation. In contrast, working in the mountains instilled in me immense pride as a doctor. I was directly involved in life-and-death situations, able to help patients in ways that profoundly affected their lives. This experience is something that truly deserves to be felt and appreciated which is why I think it’s an experience to be experienced.
Musa: Anything you want to add about how you dispose of waste, and trash control at base camp?
Dr. Joshi Njo: The waste management system at Everest Base Camp is fascinating and is overseen by the Sagarmatha Pollution Control Committee (SPCC). Each camp is required to carry out its own waste, ensuring that nothing is left behind. This year, I noticed an increase in camps hiring porters to transport equipment and trash down from the base camp.
One notable aspect is the urinals, which are directly dumped on the glacier. And that is concerning, while human feces are collected in drums and disposed of in Gorakshyap. This method could benefit from more scientifically informed approaches to disposal sites and burial methods. However, it’s encouraging to see the significant efforts made by the SPCC and the Nepalese Army. This year, we shared a tent with the Nepal Army Cleaning Campaign, which successfully removed 10 tons of waste from Camp 1 and beyond, including five bodies with few of them dating back to the 1980s.
While there is still much room for improvement, it was uplifting to witness these initiatives in action. Notably, a new system requiring climbers to carry their own waste was implemented this year, with the local government providing free poop bags and monitoring compliance. I believe that stricter regulations in the future will further contribute to a cleaner mountain environment.
Although I haven’t ventured beyond base camp, I’ve seen videos depicting the significant waste accumulation at higher altitudes. There is a need for coordinated efforts between the Nepal Army, SPCC and Sherpa teams to tackle this issue effectively. Raising awareness among climbers and trekking companies about their environmental responsibilities is crucial for fostering a cleaner climbing community.
Despite existing challenges, I remain optimistic about the progress being made, particularly with the collaboration between the Nepal Army, SPCC, and local government and intersectoral collaboration. This year, for instance, I observed a drone capable of transporting around 30 kg of waste from Camp 1 to Base Camp by Airlift Technology Company showcasing the potential of advanced technology in waste management. With ongoing efforts, I believe we will see a much cleaner version of Base Camp in the coming years.
