Preparation and Medical Outcomes of Nepalese Staff and Porters Compared with Foreign Nationals on the Annapurna Trekking Circuit

Abstract

This cross-sectional study investigates preparedness and medical problems in Nepalese staff and porters compared with foreign nationals trekking at altitude in the Nepal Himalaya. 331 Nepalese and 338 foreign nationals in 61 trekking groups were surveyed over 4 weeks on the Annapurna trekking circuit. Foreign nationals reported that 92% of trekking groups received altitude illness information and carried a medical kit. However, fewer than 30% knew the evacuation insurance status of the Nepalese staff and porters on their trek, 39% would not pay for an ill Nepalese national's helicopter evacuation, and 41% reported insufficient resources to carry an individual. Medical problems occurred in 44% of groups. A significantly higher proportion of Nepalese staff and porters were evacuated compared with foreign nationals. No significant differences in Nepalese and foreign national preparation were found between groups with and without medical problems. Medical problems were commonly encountered, yet many groups lacked resources to evacuate someone dangerously ill. Foreign and Nepalese nationals have a duty of care towards each other; recognizing that preparedness relies not only on a first aid kit, but also on knowledge of acclimatization and individuals' insurance is an important part of health and safety for individuals trekking at altitude.

Local Porters in Nepal: Acute Mountain Sickness and Load Weight of Cargo Carrying

“…These results are comparable with earlier information, which also established a larger quantity of porter evacuations when compared to other staff and tourists (Basnyat & Litch, 1997). When tallied, the data indicate that when porters describe AMS problems, they are more acute than those experienced by tourists (Drew et al, 2011). Thus, high altitude employment (portering) in the Himalaya is conceivably the most precarious of all practices of mountain tourism (Shrestha, 2020;Bott, 2009).…”

“…Contrasted with other Nepali staff, porters are frequently from humbler social environments, live at lower altitudes in the "off season", and are paid lower amounts when compared to guides, for their trekking expertise. Additionally, cultural disparities in illness and ailment communication may mean that international trekkers are less equipped to protect their workers because they are ill informed about medical complications (Barott, 2018;Drew, et al, 2011).…”

A Review of Medical Problems in Himalayan Porters

“…One study done in the Annapurna region highlights medical problems in both Nepali and foreign nationals in the route. They report fewer medical problems in the Nepali nationals (porters and staff) compared to foreign tourists (Drew 2011). However, they also mention that this might reflect lower reporting of perceived problems in the porters as compared to trekkers.…”

“…All studies that have looked at medical problems in porters, have mentioned gastroenteritis and diarrhea occur commonly. However, the rates of diarrhea in porters was reported to be less than the trekkers travelling with them (Basnyat 1997, Drew 2011. Diarrheal illnesses can be very incapacitating for the porters andthey may continue to carry heavy loads despite being dehydrated as they may not complain due to the fear of losing their job.…”

“…Other diseases: Uncorrected refractory errors, photokeratitis are more common in porters owing to lack of proper protective gear as well as reluctance to seek health advice (Gnyawali 2017, Basnyat 1997, Drew 2011. Gastritis, commonly known among locals as the "national disease of Nepal" is also well reported (Drew 2011).…”