Back to the elements

Our recent holiday in Kenya was special. And we, to be more precise I, went with serious concerns. The UK had declared that civil unrest made the country unsafe for holidaymakers. Friends warned us about the dual dangers of altitude and buffalo – unlike lions and elephants, buffalo are plain spiteful. And research on the web told me that medical provision could be hard to come by, a deficiency abroad that always makes me anxious. Our age generally, and my prostate in particular, were the worries.

As with many holidays, it is moments that are un-photographable that stay in the mind longest. We went with Lucy who knows and loves Kenya and who had organised the trip, and the particular ‘moments’ started in the departure lounge at Heathrow. While waiting for the plane she suggested that when we were in the log cabin on Mount Kenya’s foothills, I might like to give talks on mountain sickness and on any other medical issues that might arise. She would certainly love to know more about the condition, and felt that our mountain guide (John), his assistant (James) and our cook (another John) would be fascinated. Rohan added that she too would be interested. From that moment my evenings were bespoke.

Yes, I was a doctor and was used to giving talks, but my knowledge of mountain sickness has never been more than patchy. More worrying, when I later searched the internet, which I did at a two-day acclimatisation stop at 2000 metres, I soon realised that nobody else knew much about it either. I was essentially on my own. Moreover, I discovered that the cabin on the mountain had no electricity, and so no lighting and certainly no audio-visual aids. By the time we left on our drive up the next 1000 metres I had bought an A3 pad of paper and two thick ‘magic markers’ – one red, one black.

Word had gone on ahead, and as soon as we arrived I learned that John and his team were excited about the talks. I also realised that all three had left school at around 16, knew very little about ‘science’ or ‘biology’, and that their vocabulary in English was good but limited. I also discovered that all three were thoughtful, inquisitive and had an infectious thirst for information and understanding.

As dusk fell on the day of our arrival –a Sunday – Lucy arranged some chairs around a table and sat us all down. The first talk began with the word ‘OXYGEN’ written large on the centre of sheet one. With their perseverance, with regular breaks to answer their questions, with the liberal use of analogies (‘think of red blood cells as trolleys on rails carrying oxygen around the body’), and with use of the make shift flip-chart, key ideas were formed. Somehow, by the end of our allotted 30 minutes, we had covered the fact that Oxygen is an essential energy giver and that without it we die; oxygen is found in the air; that oxygen gets into the body through the lungs and then goes on to the muscles, or brain etc having been carried there in the blood which is pumped round the body by the heart. Importantly, at 3000 metres the pressure of the air is low so pushing oxygen through the lungs to the blood is more difficult, resulting in less oxygen in the blood and a feeling shortness of breath. Accordingly if a person had a particularly large number of red blood cells, and a strong heart with which to pump, as happens in those who are acclimatised, shortness of breath would be most unlikely.

Now shortness of breath is only one problem for those who suffer altitude sickness. There is sleepiness, headache, nausea and vomiting, coma and worse, but the cause of these has little to do with the lack of oxygen itself. To learn about this they would have to wait till the next day.

On the Monday we climbed to 3400 metres. To everybody’s surprise, particularly mine, Rohan got very short of breath and I managed without breathing trouble. However my legs did feel a little wobbly on the way down while hers remained steadfast. All this needed some explanation, and that evening the difference between heart fitness (I cycle hard each day in the gym) and leg fitness (Rohan walks 14km once or twice a week) was explained. Then it was on to talking about how those other features of altitude sickness (sleepiness, sickness etc) might arise, and how acclimatisation worked. And the questions and asides suggested that the ideas were being understood.

On Tuesday we pottered around at base for fear of repeating Rohan’s horrible feeling of breathlessness, and that evening the talk became more a question-and-answer session. We covered inflammation of the pancreas, heart attacks, cancer, stress, depression, and ‘healthy’ lifestyles. Then, on Wednesday it was off back down the mountain.

The talks were a real joy for me, not just because of the intellectual challenge they presented but because of the pleasure that sharing gave. Clearly something special also occurred for John and his team. It was not just the new knowledge and understanding that they gained, but, as John explained, it was the idea that they had the right to question and to know, that he found so exciting. He pressed me to stay on for another year or so, but I had to decline. Whatever else I remember about Kenya, those surreal moments together in the semidarkness half way up the mountainside will persist. Thank you Lucy for the challenge.