High Altitude Pilgrimage Medicine

Abstract

Religious pilgrims have been going to high altitude pilgrimages long before trekkers and climbers sojourned in high altitude regions, but the medical literature about high altitude pilgrimage is sparse. Gosainkunda Lake (4300 m) near Kathmandu, Nepal, and Shri Amarnath Yatra (3800 m) in Sri Nagar, Kashmir, India, are the two sites in the Himalayas from where the majority of published reports of high altitude pilgrimage have originated. Almost all travels to high altitude pilgrimages are characterized by very rapid ascents by large congregations, leading to high rates of acute mountain sickness (AMS). In addition, epidemiological studies of pilgrims from Gosainkunda Lake show that some of the important risk factors for AMS in pilgrims are female sex and older age group. Studies based on the Shri Amarnath Yatra pilgrims show that coronary artery disease, complications of diabetes, and peptic ulcer disease are some of the common, important reasons for admission to hospital during the trip. In this review, the studies that have reported these and other relevant findings will be discussed and appropriate suggestions made to improve pilgrims' safety at high altitude.

Acute mountain sickness (AMS) in a Nepali pilgrim after rapid ascent to a sacred lake (4380 m) in the Himalayas

“…There are several high-altitude pilgrimage sites in South Asia which are annually visited by millions of pilgrims. The important ones are Kailash Manasarovar in Tibet (>5000 m, estimated pilgrims annually 40 000); Gosainkund (4380 m, estimated pilgrims annually 10 000–20 000), Muktinath (3700 m, estimated pilgrims annually 30 000), Damodhar Kunda (4800 m, no data available on annual estimated pilgrims), Dudh Kunda (4500 m, no data available on annual estimated pilgrims) and Tilicho Lake (4900 m, no data available on annual estimated pilgrims) in Nepal; and Sri Amarnath (3800 m, estimated pilgrims annually 400 000–600 000), Kedarnath (3500 m, estimated pilgrims annually 600 000) and Badrinath (3100 m, estimated pilgrims annually 100 000) in India 6…”

Analysis of the mountain sickness of tourists in China from 2015-2017

“…In research on mountain sickness identi cation, researchers use the Lake Louise score (LLS) [20][21][22][23]and visual analogue score (VAS) [24][25][26] to identify acute mountain sickness. The internal factors that affect acute altitude sickness include obesity [27], age [28][29][30], sleep [31], hydration and in ammatory response [32], and psychological factors [33]. The external factors include low temperature, dryness, hypoxia [33].…”

Psychometric Validation of Hindi Version of 2018 Lake Louise Acute Mountain Sickness Scoring System

“…Even though the demographics are not available, the authors have arbitrarily observed that most of them are from Hindi-speaking regions of India. Every year thousands of worshippers from all over India travel to Shri Amarnath Yatra (12,700 ft); Hemkund Sahib (14,000 ft); Manasarovar, (14,700m) 10 . Pilgrims traveling to high altitude are a vulnerable group 11 .…”