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Accidents, Altitude Hazards to Nepal Travelers : Health: Kathmandu's CIWEC Clinic is a global leader in travel medicine. It treats 10,000 patients a year, including victims of falls, frostbite, altitude sickness and upper respiratory infection.


KATHMANDU, Nepal — The 51-year-old Dutch woman trekking through Earth's highest mountains will be remembered in Himalayan medicine as "the woman who wouldn't die."

"It's one of the more bizarre stories," said Dr. David R. Shlim, who can spin many a chilling tale about hiking mishaps. Shlim, a native of Portland, Ore., is director of the CIWEC Clinic in Kathmandu, a one-of-a-kind facility that offers Western health care to travelers in this poor Asian capital.

The Dutch woman, hiking with her husband and a small group, developed severe altitude sickness and lapsed into a coma at 15,000 feet.

The common treatment for the illness is a quick retreat to lower elevations. "Normally, if you carry somebody in a coma up higher, they're going to die," Shlim said.

But at the stubborn insistence of her husband to press on, Sherpa guides carried the woman over an 18,000-foot pass. "There's this unconscious body that's being schlepped around the mountains," Shlim said incredulously.

Finally, after several days, the still-comatose woman was airlifted to Kathmandu, where Shlim first saw her. Fearing that she might have a brain tumor, the doctor ordered her flown to Bangkok, Thailand.

Amazingly, after 10 days in a coma, the woman woke up with no visible impairment. She returned home to her job as a pharmacist. Nobody understands why she survived.

A 32-year-old British woman who scrambled off an icy trail to take a photograph of a frozen waterfall wasn't so fortunate. On the way back, "she slipped and kind of laughed and slid down right in front of her friends," Shlim said. "She went off and just died. She went way, way, way down."

In Nepal, the biggest threat to travelers is trauma. "People fall down," Shlim said. "That's what kills them."

The small, private CIWEC Clinic is a global model in the now-growing specialty of travel medicine.

It treats 10,000 patients a year, including victims of falls, frostbite, altitude sickness or upper respiratory infection. Visitors to Nepal's southern lowlands, the Terai, have been brought in with rhino and bear wounds.

On top of all that, Shlim and his colleagues are internationally recognized authorities on gastrointestinal ailments, the most widespread complaint of Westerners in this part of the world.

Trekking and climbing the unforgiving Himalayas hold particular perils for tourists. So does every other type of travel in the Third World, particularly adventure and wilderness trips.

Recognizing that no physicians' organization addressed such problems, Dr. Paul S. Auerbach, chief of the emergency medicine division at Stanford University, helped found the Wilderness Medical Society about 10 years ago.

The society publishes a journal and finances research on health issues related to such adventures as mountaineering, deep-sea diving, poisonous plants, threatening animals, lightning strikes and search-and-rescue missions.

A conference called Medicine for Adventure Travel will be held this summer in Jackson Hole, Wyo. The participants will include Shlim and Dr. Peter H. Hackett, an emergency physician in Anchorage, Alaska, who scaled Mt. Everest in 1981.

The International Society of Travel Medicine has about 1,000 members and held its third biennial congress in Paris last April.

"In North America there are very few places that employ travel-medicine doctors full time," the society's president-elect, Dr. Jay S. Keystone said in an interview. Keystone is director of the tropical-disease unit at Toronto Hospital.

Most medical care for travelers, he said, is administered by family doctors, specialists in tropical medicine or infectious diseases and, in Canada, by public-health physicians.

The International Assn. for Medical Assistance, headquartered in Guelph, Ontario, maintains a global list of English-speaking physicians and data on immunization and malaria. In the United States, the federal Centers for Disease Control (CDC) in Atlanta provides medical advice on international travel.

The No. 1 disease for travelers in the Third World is malaria, said Dr. Hans Lobel, who is in charge of malaria surveillance at the CDC.

In Nepal, 14 of every 100,000 trekkers die, CIWEC Clinic studies have shown, and three of every 1,000 technical climbers die. "One is very safe, the other is very dangerous," Shlim said. Only three hikers died of altitude sickness in three years.

Contrary to common belief, he said, altitude sickness is more likely to kill someone on an organized trek than an individual hiker.

"They've told everyone they're going to the high mountains near Annapurna or Everest," Shlim said of the typical victims. "They've saved up their whole lifetime to do it. They're very goal-oriented."

With limited time and minimal acclimatization, they become ill but don't tell anybody and keep moving up--the worst thing they can do. They die before they can be evacuated by helicopter.

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