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At the base of Mount Everest sits Everest ER, a medical clinic that deals with headaches, diarrhea, upper respiratory infections, anxiety and other physical ailments daily. (Molly Loomis)

Inside the ER at Mt. Everest

Dr. Luanne Freer, founder of the mountain’s emergency care center, sees hundreds of patients each climbing season at the foot of the Himalayas

smithsonian.com

A middle-aged woman squats motionless on the side of the trail, sheltering her head from the falling snow with a tattered grain sack.

Luanne Freer, an emergency room doctor from Bozeman, Montana, whose athletic build and energetic demeanor belie her 53 years, sets down her backpack and places her hand on the woman’s shoulder. “Sanche cha?” she asks. Are you OK?

The woman motions to her head, then her belly and points up-valley. Ashish Lohani, a Nepali doctor studying high-altitude medicine, translates.

“She has a terrible headache and is feeling nauseous,” he says. The woman, from the Rai lowlands south of the Khumbu Valley, was herding her yaks on the popular Island Peak (20,305 feet), and had been running ragged for days. Her headache and nausea indicate the onset of Acute Mountain Sickness, a mild form of altitude illness that can progress to High Altitude Cerebral Edema (HACE), a swelling of the brain that can turn deadly if left untreated. After assessing her for HACE by having her walk in a straight line and testing her oxygen saturation levels, the doctors instruct her to continue descending to the nearest town, Namche Bazaar, less than two miles away.

Freer, Lohani and I are trekking through Nepal’s Khumbu Valley, home to several of the world’s highest peaks, including Mount Everest. We are still days from our destination of Mount Everest Base Camp and Everest ER, the medical clinic that Freer established nine years ago, but already Freer’s work has begun. More than once as she has hiked up to the base camp, Freer has encountered a lowland Nepali, such as the Rai woman, on the side of the trail ill from altitude. Thankfully, this yak herder is in better condition than most. A few weeks earlier, just before any of the clinics had opened for the spring season, two porters had succumbed to altitude-related illnesses.

Each year over 30,000 people visit the Khumbu to gaze upon the icy slopes of its famed peaks, traverse its magical rhododendron forests and experience Sherpa hospitality by the warmth of a yak dung stove. Some visitors trek between teahouses, traveling with just a light backpack while a porter carries their overnight belongings. Others are climbers, traveling with a support staff that will aid them as they attempt famous peaks such as Everest (29,029 feet), Lhotse (27,940 feet) and Nuptse (25,790 feet). Many of these climbers, trekkers and even their support staff will fall ill to altitude-induced ailments, such as the famed Khumbu cough, or gastro-intestinal bugs that are compounded by altitude.

A short trip with a group of fellow doctors to the Khumbu in 1999 left Freer desperate for the chance to return to the area and learn more from the local people she had met. So in 2002 Freer volunteered for the Himalayan Rescue Association’s Periche clinic—a remote stone outpost accessed by a five-day hike up to 14,600 feet. Established in 1973, Periche is located at an elevation where, historically, altitude-related problems begin to manifest in travelers who have come up too far too fast.

For three months, Freer worked in Periche treating foreigners, locals and even animals in cases ranging from the simple—blisters and warts—to the serious, instructing another doctor in Kunde, a remote village a day’s walk away, via radio how to perform spinal anesthesia on a woman in labor. Both the woman and the baby survived.

It was during that year, on a sojourn up to Everest Base Camp, that Freer hatched the plan of developing a satellite clinic for the Himalayan Rescue Association at the base of the famed peak. While many expeditions brought their own doctors, there was no formal facility, which Freer knew could help increase the level of care. While working at Periche, Freer had seen numerous patients sent down from Everest Base Camp, and the gap between many doctors’ experience and the realities of expedition medicine concerned her.

“I saw several well-intentioned doctors nearly kill their patients because they didn’t understand or hadn’t learned proper care of altitude illness and wilderness medicine,” she says. The mountain environment had always held an allure for Freer. Upon finishing her residency in emergency medicine at Georgetown University, she headed west for the mountains, landing a job as a doctor in Yellowstone National Park, where she still works full time, serving as the park’s medical director. Freer is a past president of the Wilderness Medical Society, and her unique niche has taken her not only to the Himalaya but also to remote places in Africa and Alaska.

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