High Roads News Sticky , 2015

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Manali Standoff , take two ( July 9th ) : NGT new hearing set to July 16th.

July 6th : National Green Tribunal shut down all tourist activities at the Rohtang after previous court orders have been flaunted ( five thousand vehicles yesterday vs the permitted one thousand etc ) – and  dock the pay of a number of Manali officials until changes are made.

SAACH PASS OPENS , JULY 4th : this means finally all four routes to Leh are open.

SPITI UPDATE , JUNE 25TH : Manali-Kaza still officially closed ( i.e. no buses yet ) , despite all contrary rumors. Bad , bad conditions from Gramphu and eastwards with snow and slush. Heavy rain predicted , also on the Shimla/Kinnaur route.

J&K and Himachal weather update , June 23rd : monsoon kickoff , heavy to very heavy rain predicted coming days.

Manali , May 26th : Supreme Court upholds the ruling of the National Green Tribunal : max 1000 vehicles per day to the Rohtang La , and a two tier tax on regular vs diesel vehicles.

LADAKHI INROADS :

JUNE 13TH : MANALI-LEH OPENS , 2015 : confirmed on official Leh site , all vehicles , June 16th

Light traffic only , still not confirmed from Le. Weather coming days : thunder , rain and some clouds. Interesting days.

June 6th : Border Roads reaches the Baralacha La . Remaining road to be cleared Baralacha La to Sarchu , Leh-Sarchu already open.

June 3rd : Rohtang weather coming days : snow and rain. + 4 degrees lowest nights in Keylong , still just under zero at the Rohtang.

May 28th : Manali Taxi Union strike ends : same traffic limitations to the Rohtang , taxes on hold  until June 8th.

May 26 : Snowfall over the Rohtang and in Keylong (!) takes out the road again.

Manali , May 22nd : Supreme Court rejects Manali Taxi Unions plea for a stop to the traffic limitations to the Rohtang  La & diesel tax. Full hearing May  26th. Manali , May 20th : very calm days on the road below the snowline , with the NGT cap  and taxi union strike. See separate post below. When the traffic over the Rohtang resumes : 1) no traffic on Tuesdays , same procedure as every year , only Border Roads  maintenance 2) second priority HRTC buses for Lahaul , and eventually Leh . 3) third priority Rohtang day trippers , only 1000 vehicles per day , and the new diesel tax. Manali-Leh , May 15th : Rothang La open for cars , not buses . Open road from Keylong to Darcha. Temperatures still dancing just above/below the freezing point at the Rohtang La : still time for more avalanches. May 11h  : HRTC buses now running from Koksar ( north side of the Rohtang ) up to Key long . May 4th :  Rohtang cleared from Manali beyond Marhi  up to Rani Nullah  , i.e. six kilometers from Rohtang top. On the north side the bulldozers have grinded to a halt , after using up all the stockpiled fuel. Fuel to be airlifted in.

Srinagar-Leh fully open , May 25th

Srinagar-Leh OPEN  , May 8th : Light vehicles only first , buses and trucks to follow after more work by the BRO. Fresh veggies for all  – congrats ! May 2nd : first crossings of the Zoji La – on foot. April 18th : Zoji La cleared almost cleared now , from both sides. Borders Roads new goal to open within a week .Weather forecast coming days : mix of clouds , some more snow at the high end of the road, and later sunny .

ZANSKAR : Kargil-Padum road open

SPITI  UPDATE June 23rd : some second and third hand reports of the Kunzum La now opened , no details. June 7th : open road  Shimla-Kaza-Losar , BRO has ( one report so far ) reached the Kunzum La.  . Manali-Kaza still closed after Batal .

NEPAL , MAY 12th : NEW 7+ EARTHQUAKE, epicenter 68 klicks west of Namche Bazaar. Friendship Highway from Kathmandu to Lhasa out already after the first earthquake – massive destruction in Kodari

Manali Standoff

Todays hindi expression : chakka jam . A sit down protest – with cars. Manali has come to a near stand still as the National Green Tribunal actually almost stod it’s ground on the issue of banning diesel traffic up to the Rohtang La pass. In the end the long forewarned decision was transformed in to a cap on the total number of vehicles , and a heavy tax on diesel vehicles. Little love was won by this compromise.

The stakeholders in the conflict , with or without active advocates :

* the Rohtang La biotope , crossed by the “Great White Snake ” : Thousands of  four wheel drive cars , leaving a trail ..less than white behind them . Pristine white snow in beginning of the season turns more and more in to something resembling the floor of a oil pit in a auto shop.

* the Manali taxi drivers , who rightly remarks that paying five thousand rupees won’t make the vehicle less of a burden for the environment.

* the day tourists , many of whom have the chance of ” touching the snow” at the Rohtang as a key driving factor for coming to Manali . And now , when even the weather gods have been conspiring against them , found out yesterday that they can’t even come up to the snow line : the road always closes on Tuesdays so that Border Roads can do some effective road work. Right now the road past Marhi at 3000 meters is basically a one lane tunnel in the snow – see the photo in the sticky above.

* the Lahaulis on the other side of the pass , waiting for the first fresh veggies and provisions in months since the road closed for the winter .

* the military , who hardly needs any advocates : the Manali-Leh road probably shouldn’t even exist without the backdrop of the Aksai Chin war and the tension between India and Pakistan. At least not as early as as in 80’s.

Short term there are only two winners at the moment : the Lahaulis have a chance of seeing the road not being one of the slowest roads in India ( often five hours or more for the fifty-ish klicks from Manali to Rohtang top) in peak season. The other winners are the tourists who choose to stay and take the tour buses … until the taxi drivers block them as well.

Long term the needs of the Army and locals will be solved by the Rohtang tunnel , but that’s years off still. The tunnel won’t make any real dent in the heavy traffic over the actual pass though , except in eliminating the heavy traffic nowadays the first week(s) after the spring opening.

The mid term solution is more people in less vehicles , i.e. ( clean , CNG ) buses. Like the HRTC buses plying the full Manali-Leh road these need to be custom made : bigger than the minibuses , but still with short enough wheelbase to navigate the hairpin curves.

The really bold move here would be going for a cable car ( rope way , as the Indians put it) . This would the litterally long term solution , since it would make Rohtang La a round the year safe attraction ,like the Jade Dragon.

And yes , there is a common denominator here : the taxi drivers will suffer horribly. Sometimes everyone can’t win . Maybe this conflict will be a preparation for Delhiites in what must come at home as well : Delhi has one of the best Metros in the world – and this isn’t enough. It also has some of the foulest air in India ( and Asia , worse than Beijing ) , and this won’t change until the traffic situation changes drastically there as well.

Kathmandu Earthquake

Mounting death toll in the 7.8 earthquake , latest estimate around one thousand. Effects go way beyond the Kathmandu Valley , including eighteen dead climbers on Mt Everest . The epicenter of the second , smaller ( 6.6 ) quake close to the start of the Annapurna Circuit .

* Tribuhvan airport is out : first for repairs , and after that military aircrafts will have priority. Indian Air Force is sending in Hercules and C130 planes with rescue personell and supplies.

* Friendship Highway to Lhasa is out .

* no clear word on the Everest Base Camps , on both sides of the border. now would not be a good time.

Everest : The Hidden Story Behind The First Ascent

History. Change.

A few times it comes down to a few people . Or just one.

In 1993 a great anniversary reception was made , celebrating the first Everest ascent. All the expected persons were found on the stage , and given their due respect. And then the expedition doc Michael Ward touched a well hidden raw nerve , saying ( condensed version )

” we’ve been told that that we succeeded because of our outstanding British climbers , good leaders and strong organisation. Well , we had all of that on earlier expeditions , and we failed. Not once or twice , but eleven times. ”

He then named the final deciding factor in reaching the top : a better understanding of how the human body works , delivered by the physiologist Griffith Pugh , and taking the consequences from that .

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Pugh was what we’d today would call a boots and GoreTex doc, starting as a Army doc , training British soldiers in mountain warfare during WW2. Coming in to contact with the Everest effort he recognised that that climbers failed ( and ultimately often died ) from the same factors seen in the battlefield . They failed from being exhausted from dealing with cold conditions , and being starved on water , food and oxygen. Pugh then set out systematically to change all of that. He started with redesigning clothes : exchanging buttons for zippers. Introducing taffeta lining so that the anoraks would go down , and stay down , instead of hitching up from the backpack movement. New fabrics . Constructing new double walled tents , and having them tested first in wind tunnel labs , and then on the mountain. New sleeping bags that allowed turning in your sleep. The first inflatable ground pads for climbers.

Having dealt with cold , Pugh went on to food , and introduced the ration model we today still recognise not only from climbing expeditions but also from the International Space Station. One part very well calculated rations that will cover all the essential needs of the body – and one part personal favorites chosen by each member , the stuff that makes you want to go on.

Pughs first goal however was to end oxygen starvation , and making the climbers of the 50’s accept the use of oxygen was a long and bitter fight . It had already cost the first expedition leader his job , which didn’t mean that his successor Hunt was an enthusiast.

Climbers had two reasons for their resistance . One was tradition , seeing the use of oxygen as cheating. The other reason came from bad experience. The first oxygen rigs were basically bomb plane equipment ripped out from the cockpit , giving the flow rates that had proven to work well for pilots sitting in a chair. Climbers rightfully bitterly complained over the result : heavy equipment meaning more work with little relief from the extra oxygen. Lighter kits and more than double flow rates made a dramatic change , both in how climbers performed and in accepting the idea.

Having calculated and changing the rations of food and oxygen Pugh went on to the fluid rations. The British rations were extremely low , around a half liter per day. Pugh came up with what was called “copious ” drinking at that time. The problem came from the storm kitchens used at the time : Pugh introduced new kitchens and carrying enough fuel to smelt snow and ice efficiently.

This last part came to be the least understod of the changes Pugh introduced. It’s not even clear that Pugh made any connection between dehydration and altitude sickness – a common idea that many have tried to prove , with miserable results.

The fluid rations that took Hillary and Tenzing to the top …this is the part where many will start to guess wildly , starting from 5-6 liters per day . Actually it was 3-4 liters , and this is still the the recommendation from for example the Himalyan Rescue Association , after three decades of experience of running the Pheriche first aid clinic enroute to Everest. It also comes with a warning of the risks of binging on water. The Everest success led to a tradition of stressing fluid intake , taking it to another extreme. Today we know both that you can’t perform well on low, low water rations – and that the other extreme is at least as harmful : there are well documented deaths after extreme water intake , at all altitudes. This is slowly getting acknowledged despite the high water intake theory has been a pet project for a long time : last year British National Health Service finally gave up their recommendation that all visitors at any altitude , any degree of activity should drink almost the double ration of Hillary and Tenzing ( 4-6 liters ) , and halfheartedly replaced it with ” plenty of fluids”.

( This is lightly polished version of an evening talk at the SECMOL school , involving a bucket of water going round and nearly half being thrown out the door : ” this is not the Middle Way ” . A lot came from Pughs recently published biography , Everest – The First Ascent . State of the art on info fluid balance at altitude can be found in the evidence based guidelines from WMS at http://korta.nu/wem under ” other options” . )

BAI Award 2014 : Soroche Pills

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This years Bad Altitude Info Award goes to Crespal Labs in Peru , for their suggestion to medicate against altitude sickness at Macchu Pichu – which will be the lowest point reached by 99% of Andean tourists . MP peak is at 2400 meters , i.e. similar to cabin pressure on airplanes , and a thousand meters lower than Cusco. The hotels in Aguas Calientes are several hundred meters lower.

Soroche Pills are often described as a local product , with hints on herbal medicine : Incan tradition vs Bad Pharma . This pans out badly when you look at the components :

ASA , i.e. Aspirin
Caffeine
Salophene

Salophene , which has been discontinued on the rest of the planet for many decades , metabolises in to more ASA and paracetamol/acetaminophen. It was marketed by the German pharmaceutical firm. Bayer in the early 20th century.

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Later Bayer became the image of not only bad but Evil Pharma with another discontinued product : Zyklon B.

This years runner up for rubbish non-commercial info is the Norwegian independent drug info site Relis.no , intended as a guide for prescribing doctors. Their posts on AMS prevention ( høydesyke ) contains repeated mentions of up to five times higher acetazolamide doses than present guidelines – and points to an article from the Norwegian Medical Society journal as source , which says the opposite.

Worlds Highest Cable Car

Up , up and away : grand day out starting from Lijiang in Yunnan at 2400 meters , taking the cable car to 4506 meters , topped by stair excercises up to 4680.

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4506

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4680

This is the highest running cable car in the world at the moment : the Meridian cable car reached 4700+ meters , but stopped operating in 2008. Second highest would be the Lina Rioja down to La Paz from El Alto @ 4061 meters.

Honorable mentions below 4000 meters :
* the Quito TeleferiQo claims to go up to 3945 meters , starting from 3117 , which checks out on Google Earth
* the Gulmarg gondola makes two different claims on their official homepage : 3747 meters ( around thirty meters lower than the the Aiguille du Midi in Chamonix ) and 3979 meters . The later is clearly an exaggeration , Google Earth places it a few meters below the Quito Teleferiqo. A second level of exaggeration is often found on Indian websites , giving not the altitude of the cable car station but the top of the mountain , starting from 4200 meters.

* The Aiguille di Midi in the Mont Blanc massif at 3842 meters

* Yunnan holds another cabe car going from Kangding at 2600 meters , reaching .. have to check that with a GPS next time around.

Higher Learning , For Free

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High Altitude Medicine & Biology , the best perk of working at a university hospital , is running a short period of free online access right now. This is a gold mine for everyone who is interested in hard data based articles on high altitude physiology and  medicine :
* Horrendous fail rates on Kilimanjaro , way outside all guidelines in Prevalence of Acute Mountain Sickness among Finnish Trekkers on Mount Kilimanjaro, Tanzania  

* Report from the first run on the Beijing-Lhasa railway ( first train in world with onboard oxygen generators ) , and how effective this is in preventing altitude sickness

* The article the Finns , and everyone on fast , fixed itineraries should have read first : Altitude Preexposure Recommendations for Inducing Acclimatization

 

On top of this is there is a lot of medical history , with still highly relevant results. There is a whole issue dedicated to the 50 year anniversary of the Silver Hut expedition , still a benchmark in the effects of extreme acclimatization : five months spent at 5800 meters , followed by bringing down more physiological data from up to 7400 meters. Those who still believe that it’s essential to push large volumes of fluids will struggle with the fact that that Milledge and the other members managed well on around three liters of fluids per day , including climbing up to 7000+ meters.
One of the results of going thru this issue that I’ve just dived in to the man and explanation of why the Hillary/Tenzing ascent succeeded , after seven British fails in a row : Griffith Pugh , the picture perfect mad scientist and genius that that pushed a kicking and screaming climbing fraternity in to a physiological approach to climbing : using oxygen , planning nutrition, designing tents and more.

Gentiana , Snake Bladders & Sulphur : Bad Altitude Info Award 2013

Best contender so far  this year : the Tibet and Lhasa Health & Safety section on Lonely Planet , about the (perceived ) dangers of Diamox treatment : 

“the use (of) Diamox is controversial. It can reduce symtoms , but may also mask warning signs. Severe and fatal cases of AMS has occured in people taking this drug.”
The advice seems well researched at a first glance , correct doses are given and there are a number of sources at the end of the document.

It has a number of serious problems though , starting with
fake sources
LP lists a number of sources / suggested reading … which all are very solid , and all say the opposite of what LP claims .

*Pollards classic High  Altitude Medicine Handbook , a given in my backpack since many years : 

” there is no evidence ” that Diamox has a masking effect. Feeling better with Diamox comes from the increased ventilation made possible by Diamox.  

*Richard Dawoods Travellers Health. Dawood worked three seasons with The Himalyan Rescue Association clinic in Periche  and one one can safely assume he agrees with their position on Diamox/acetazolamide : “the most tried and tested drug both for altitude sickness treatment and prevention… unlike dexamethason this drug does not mask the symtoms but actually treats the problem” 

The main reason Dawood would agree on this is that he is the author  , the AMS section in his book and on the HRA site are identical…

*Pocket First Aid & Wilderness Medicine , by Duff and Gormly : ” Azetazolamide increases the breathing rate at altitude and speeds up the acclimatization process… Acetazolamide does not mask the onset of AMS , HAPE and HACE”

 

* Last but in no way least : CDC , which are responsible for the national health guidelines in the US. CDC has consistently pushed for better/wider acceptance of preventive medication with Diamox in their altitude advisory ( shortlink : http://korta.nu/cdcalt ) . This year they published a separate Cusco advisory . Cusco is lower than Lhasa , and wording is more direct now : everyone travelling to Cusco should be prepared to prevent or treat altitude sickness with Diamox. 

 

DEAD TREE DEPENDENCY 

Finding today anything written that can’t point to  a single online resource gives a weird 90’s feeling. And the resources have been out there for a looong time : the High Altitude Medicine Guide and the Himalyan Rescue Association sites were both up in ’95 , soon followed by the International Society for Mountain Medicine and CDC . Any  of these sites will for example point out that the most efficient medication is oxygen , which never comes up at LP. This could be an atavism going back to first printed Tibet LP guides , saying that the effect from oxygen is “mainly  psychological” (!)

TRADITIONAL , TIBETAN OR WESTERN

 

LP brings up a number of alternative medications. First up is Rhodiola , which is called a Tibetan herbal medicine. Reading this as a uniqe local tradition is definitely off the mark : Rhodiola grows over wide areas over the world  , including Russia , Sweden and China . The search for a  medical use of Rhodiola started in the classical  Greek period, re-surfaced with Carl von Linné and … Josef Stalin, the later being the main reason westerners today are aware of Rhodiola.  The fuzzy wording “recommended by locals” leaves no clue if this is to be seen as a part of the Tibetan medical tradition , or if this is a word on the street thing , like the infamous soroche.  pills in South America. 

The entusiasm for non-proven medication is not limited to Rhodiola : the proposed medication list also includes Gentiana against AMS , which will  baffle …, basically everyone , including doctors and herbalists. To top it off the litteral Snake oil cures comes up : the classic Chinese cure of dried snake gall bladders against pneumonia (!) is mentioned.

 

Extra points for bringing up “Sulphur allergy ” ( Sulphur is an essential trace element , used in the body) . The mixup here is with sulfonamides , where allergic reactions are  in no way is certain between the antibiotic sulfonamides ( “sulfa” ) and the non-antibiotic group , like one of the worlds most common prescription medications , the diuretic furosemide.