Kilimanjaro is known as “Everyman’s Everest.” Although it’s the tallest peak, in Africa, and the highest freestanding mountain in the world, the route to the top – at 19,341 feet – has become a relatively easy trek. You don’t need ropes or mountaineering experience. As a result, about 40,000 people make the attempt to climb it each year. But more than half fail in their attempt. The reason? Acute Mountain Sickness (AMS), commonly called altitude sickness. At the summit, air pressure is so low there is only half as much oxygen as at sea level. It’s like living in a partial vacuum. The sickness hits people in different ways, most often with headaches, nausea, vomiting, insomnia, disorientation and exhaustion.
In the worst cases AMS turns into two conditions that can quickly kill you. With High Altitude Pulmonary Edema, fluid seeps into your lungs so swiftly you literally drown in your own juices. With High Altitude Cerebral Edema, fluid leaks into your brain. This affects your balance, your memory, and can even put you in a coma.
On average ten trekkers die each year on Kilimanjaro–most from to altitude sickness, and a few due to rockslides. (Sadly, no statistics have been compiled on the numbers of porters and guides who perish). Ten deaths in 40,000 is only .025 percent. If it were a batting average, it would be a 99.975 percent survival rate. This might seem like not too bad a risk. Unless you are one losing consciousness on the rim of a remote African volcano. What makes altitude sickness particularly tricky is that you never know who is going to get it. You can be young and fit and it might kill you. Or you can be old out of shape, just shuffling along, and you’ll be fine. In fact, the oldest person up Kilimanjaro was an 87 year old Frenchman, while tennis champion Martina Navratilova had to abandon her climb when AMS hit her hard.
The single best thing you can do to reduce your vulnerability to AMS is follow Kilimanjaro’s Golden Rule:
“Slowly, slowly, ” the guides all warn.
You don’t rush. You let the guides set the pace. If you have trouble breathing, or headache or you feel like vomiting, you tell them. Don’t try to tough it out. Let them make the assessment of how you are doing. A one climber explained to me: “Your guide is like your guardian angel. His most important job is to get you safely back to your loved ones.”
Some outfitters take no chances. They bring oxygen bottles, or even a portable hypobaric chamber for emergencies (You climb inside and they pressurize the chamber to mimic lower altitudes). I did not meet many climbers on the mountain who brought this failsafe equipment along. Outfitters who do use them have grim stories to tell of trekkers who died needlessly because they did not come prepared.
But many trekkers are willing to live with some degree of risk. For them, there is one simple precaution you can take: Diamox.
Diamox is the brand name of Acetazolamide, a prescription medicine used to reduce the severity and duration of symptoms of AMS. It helps with nausea, headache, shortness of breath, dizziness, drowsiness, and fatigue). It works by acidifying the blood. This makes the red blood cells transfer more oxygen. It creates the good effects of acclimatization.
But what I didn’t know until I was high up Kilimanjaro is that you are not supposed to take Diamox above 5,000 meters (about 15,000 feet). That high, “you can’t tell what will happen. Any medicine can have unpredictable effects. It can hurt you very, very quickly. So you have to wait until we get to lower altitudes to take any pills” – this was the explicit advice of my seasoned Tanzanian mountain guide.
For more information on medical risks associated with climbing Kilimanjaro and visiting Tanzania, please check the Medical Commission of the International Mountaineering and Climbing Federation (UIAA). The UIAA’s medical commission provides a medical information service for mountaineers, including a Their purpose is to give mountaineers reliable, practical advice and the most up to date recommendations on medical issues in the mountains. They function as a world-wide forum of doctors who are specialized in the different fields of mountain medicine. They collect, evaluate and discuss medical data from experts around the world and try to reach an international consensus on difficult issues of prevention and treatment of illness and injuries. They regularly publish recommendation papers which are available to everybody on the UIAA webpage. The UIAA’s research includes issues of mountain equipment safety, diseases and altitude sickness, as well as Climate Change, sustainable development , and supporting mountain cultures around the world.”
Diamox: National Institute of Health
NIH has a valuable page on Diamox. Please research your options well for preparing for altitude sickness. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000766
You can read about my own experiences with AMS while climbing Kilimanjaro in my new book, Zombies on Kilimanjaro. www.ZombiesOnKilimanjaro.com
Tim Ward is the author of Zombies on Kilimanjaro: a Father-Son Journey Above the Clouds, the first literary narrative of climbing Kilimanjaro.
“A High-Altitude Zen and the Art of Motorcycle Maintenance” – James O’Reilly.