Organized religious tours in the Himalayas and health concerns

Frostbite can happen at 11,000 feet if you are not careful.

For Hindus, the Himalayas are a sacred destination. Char Dham Yatra is a famous one conducted by many tour companies. Kedarnath (11,567’), Muktinath (12,467’), Badrinath (10,827’) - these three are extremely popular from a religious perspective. Muktinath is in Nepal, the other two are in India. Although you can reach Muktinath by road, it is very tedious and takes many days and hence tour companies generally reach Muktinath via helicopter (and this detail is important).

There are multiple religious tour organizers from all over the country that bring people here. For instance, this travel agency is in Chennai, down south at sea level. Now, Chennai is a town where the winter month is 80F (27 C) and people use their sweaters and beanies for it. When people from here go to such high altitude it is a lot to handle and need precautions.

The folks who go on these tours are typically retired, in their 60s and 70s with little experience of mountaineering. Some of them also has pre existing conditions such as high blood pressure, diabetes and such. They have no experience hiking and they are often transported via mules or porters carrying them on their backs. These porters, like the Sherpas of Mt. Everest carry these people up and down the mountains (10-12 miles each way, climbing roughly 3,000 feet) and they do it twice a day.

My family has unfortunate history with these tours. In 2004, a bus that was carrying my Uncle and Aunt went off the abysmal roads deep near Badrinath in the valley (I hear roads are much better now). My cousin had to go identify two bodies and do the last rites in the hills and return. Such accidents are not common anymore, thankfully.

The reason to write this story is another aunt of mine elderly who raised me partly suffered in such a trips. Some things I heard from her made me very sad and I wanted to share some helpful info. I am writing this primarily for elderly people who visit the Himalayas and their children so they can ensure they are safe.

My Aunt (73 then) was part of a large group went from Chennai (sea level) to Dehradun (1,400’) via train. From there, they drove by road to Sonaprayag (6,000’) which was their base camp for pilgrimage.

From there, they took a helicopter ride to Muktinath. My Aunt was well prepared for this ride. She was wearing thermals and woolen socks and boots for the trip. However, the gain in altitude is rapid. Based on what I can decipher, my Aunt developed mild HACE during this sudden altitude gain. HACE is a condition that happens when someone travels and reaches high altitude quickly. Symptoms involves disorientation/confusion, headache, rapid heart rate, vomiting sensation/nausea, headache and such. It occurs when the body fails to get adjusted while ascending to a high altitude.

My Aunt said that her brain function slowed down and she was unable to make informed decisions. She had GI issues and was unable to sleep after she returned. In that state, she went to Kedarnath and was carried by porters. Unfortunately for her, her brain told her that she was too warm at Muktinath. Hence she did not wear her thermals, nor did she wear woolen socks or her boots and went to Kedarnath in her sandals :(. It may not have been freezing cold in the Fall of 2017, but it was bad enough exposure that she developed frostbite in both her legs.

She was back at the base camp, but gangrene set-in. The tour operators left a kid with her for support while they took care of the remaining pilgrimage. It was quite a nightmare to bring her down to Dehradun. She had immediate surgery at Dehradun to remove gangrene and air lifted to Chennai where she was in a hospital for 45 days to do skin grafting and the works. I am thankful she did not lose any toes in the process.

What could have been different?

• Tourists should ideally learn to book packages that involves staying at various elevation levels for 1-2 days to get used to that elevation level before going up and down to low elevation and avoid rushing to finish all places in a weeks time. This way body will naturally learn to adjust to function properly in high elevation levels.

• The tour operators do not seem to have knowledge of HACE or basic precautions. Diamox (Acetazolamide) medicine should have been required for these travelers at a minimum. It helps travels adjust to altitude well and avoids HACE. It never occurred to me that HACE can develop at altitudes as low as 10,000’. I wish I had told my aunt to talk to a Doctor and get a prescription of Diamox before she left.

• I am not surprised the tour operators were not trained enough to recognize HACE after it sets in. Wearing sandals when going up a few thousand feet towards 10,000’ is a clear indication the person is not thinking straight. They should some ground rules around protection and enforced them. They should have not allowed her to continue without wool socks and thermals and boots.

• I am utterly shocked that they did not recognize frostbite as it happened. First aid help needed for frostbite (warm water etc) was not given. I am thankful that she was brought down to Dehradun as soon as possible and had surgery, but I fear what could have happened.

If your loved ones in India talk about taking a pilgrimage to Himalayas, remember to ask about the tour operators mountaineering experience. Talk to your elderly relatives about HACE, Diamox, frostbite and proper head/ears/feet protection. Tell them how to recognize signs of HACE and what to do when they see it.