Srinagar, day 41

Thursday , August 18th : yet another ambulance arrives at SMHS  , Srinagars main hospital. Last in line to the emergency room is the ambulance driver , who has managed to complete the run with shotgun wounds in his hand from a roadblock. The frustration of the docs  in Srinagar has now reached the point where they have started to leak X-ray pics to the press , pics that are gruesome enough to make laymen pause.

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The theory behind CPRFs armament and strategy is  that their pellet shotguns  are non-lethal when aimed below the knees. In actual practice they have had a devastating effect all too often from the abdomen and up , shown on a near daily basis on the front page pictures since July 8th. Punctured lungs , abdominal bleedings and , the icon of 2016 : the permanently blinded. Last estimate was 400+ with severe eye injuries to one or both eyes.

Little reason to believe in any immediate changes for the better , with announced plans for continued strikes and protest marches over the weekend.

The tourist perspective checklist :

* flights to Srinagar : airlines offered full refunds for tickets at least up to the 16th.

* Jammu-Srinagar road is  open again, out first two weeks

* travel insurances are basically void during curfews etc – check the  official travel advisory back home.

* Srinagar-Leh road is open , see the updates at http://korta.nu/sticky

 

 

 

 

Third Highest Airport

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End of my 2015 tour in Kham , driving past worlds third highest airport serving Kangding @ 4280 meters . Looks like a interesting landing , with the four thousand meter long runway ending as a ramp . Think cutting of the top of a cone , and flipping it to extend the flat surface.

 

Kangding town  is forty  klicks away and seventeen hundred meters lower : flat real estate is scarce in these parts.

Worlds Highest Airport

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Landing at 4411 meters … an instant aging experience. Well , I got younger again down in Daocheng at 3750 meters. But not fast . There is a better way of doing this : a long flight to Kunming , where the airport is at 2100-ish meter, and then a connecting flight to Daocheng/Yading . Doesn’t run in the winter though.

( There are now four airports at 4000+ meters : La Paz , widely believed to be the worlds highest is the lowest one at 4061 meters. )

Small Sip of Water on the Hemkund Sahib

Todays quick read : a small pilot study on altitude sickness in Sikh pilgrims . Pilgrims progress up the Himalayas in a manner that will make experienced docs shudder , in part from a mindset that invites suffering – to a point. It is the same reality described in Basnyats Disoriented and Ataxic Pilgrims , from Gosaikhund in Nepal , where a large majority of the yatras suffered from AMS.

This small study ( 28 subjects , interviewed at the Hemkund Sahib temple @ 4330 meters ) is fuelled by two concerns : the rapid ascent , and the minimal fluid intake. The authors have set up a info page for coming pilgrims echoing the same concern about the water intake , urging a high water intake not only during but also before trekking up the Hemkund Sahib. Their main source for this is an article by Peter Hackett , mentioning advice handed out by the Himalayan Rescue Association – in 1975 (!) . This advice coming up now will surprise anyone who

* has read what Hackett ( who after extensive work with the HRA summited on Mt Everest as part of a medical research expedition , and now is the head of the Institute for Altitude Medicine in Telluride ) written on the subject afterwards :

..In reality you only need an additional liter to a liter and a half of water at altitude. Too much water is harmful and can dilute your body’s sodium level (hyponatremia) causing weakness, confusion, seizures, and coma.

* has read the advisory from the Himalayan Rescue Association over the last decade :

Maintaining adequate hydration

Adequate amounts of fluid (about 3 liters a day) are necessary in the mountains:- dehydration mimics altitude sickness and may even predispose to it. On the other hand excessive water drinking should also be avoided as this may lead to electrolyte imbalances.

( Also note that right from the start in -75 HRA talks of total fluid intake , not about drinking water : all fluids count , and the only unique value of plain water is a stronger push towards hyponatremia . )

* has read the relevant part of Hacketts first study : the outcome was that all participants lost weight , and that those who had the highest weight loss were the the ones who did not develop AMS :

Weightloss occurred in both groups , but was less in the AMS group (P0.07) . Indeed , the worse or higher the symptom score , the less the weight loss.

The other strong predictor for avoiding AMS was higher urine output. The second source quoted by Sahota and Panwar manages to find support for that . And only that.

Sources mentioned here :

Current acclimatization advice from Himalayan Rescue Association

A Pilot Study on the incidence of Acute Mountain Sickness at the Sikh pilgrimage to Hemkund Sahib

The incidence, importance and prophylaxis of acute mountain sickness – Peter Hackett & Drummond Rennie in The Lancet , 1976

Altitude Myths @ the Institute for Altitude Medicine

Nerin et al : Acute Mountain Sickness : Influence of Fluid Intake

For a non-medicalese version of acclimatization and hydration advice , see this interview with David Shlim , another veteran of the HRA clinic in Pheriche , fifteeen years as head of the CIWEC clinic in Kathmandu, and co-author of the CDC altitude advisory with Hackett.