Kilimanjaro and East Africa

A Contrasting Tragedy

I write this section because I consistently find that I am often pulled aside by people, either on my forums or in person, to make comments about "accidents" that occur in mountaineering. Usually, the incident in question is somehow related to something I've done or been involved with (for example, the recent Torngats tragedy with Dan Pauze and Susan Barnes).

Background

On January 8, 2005, Normande Langevin of Ottawa died of High Altitude Cerebral Edema (HACE) while climbing Kilimanjaro. Another party member of the expedition was apparently suffering from the symptoms of HACE as well. According to an article in a local Ottawa Canada newspaper, Ms. Langevin developed severe symptoms of HACE on the night after the fifth day of climbing (which, by my understanding, was on the night of the 7th-8th of January). The report is not clear, but they were either just below the Western Breach or just above it in the crater (based on new information from Simon Pleau, I have confirmed that they were above the WB, in the crater - JAL). According to the article, their guide then apparently told them that she should descend at once. They had to dress her (she was not able to do this herself), and then a guide and porter took her 500 metres (about 1,500 feet) down the mountain on their shoulders. It is not clear when they started giving her oxygen, but apparently they did. However, it was too late, and she succumbed to the condition sometime early on the 8th of January.

You can read the full article for yourself by clicking here.

Thoughts

The first we heard about the death of a Canadian climber was while we were at the summit on January 9, 2005 . Apparently Chombo (our guide) had been talking with another guide or porter (not sure which) from a different climbing team, and had heard the news. In fact, he may have even been talking to a member of their team. The story I heard at that time is that the person was male and had suffered from severe gastro-intestinal problems, with some sort of complication resulting in death. This may or may not have been Ms. Langevin, because apparently another Canadian (this one a male) had died also on the previous day, and this was also an altitude-related condition (I can find no detailed information on this death).

We had passed a tent or two in the crater on our way to the summit on January 9. Was this possibly a tent associated with her party?

My first observation is on how quickly facts can get distorted. It is important to remember, then, when reading second, third, or fourth-hand accounts, that one must assume that there is a good possibility that some or all of the information that you are hearing is in some way inaccurate. It is easy to hear a well-written account of a tragedy, and then go off and make all kinds of assumptions based on that account. I believe this is a mistake.

The article's slant is such that the blame is placed fairly squarely on the guide. The title says "African guide failed to recognize symptoms". Further on in the article, it says that the guide said everything was normal despite their discomfort (nausea and vomiting), and that they should continue.

Now, before continuing, let's get a few facts straight: AMS stands for Acute Mountain Sickness. AMS comes in a very broad range, from very mild to very severe. At the severe end of AMS are the conditions of HAPE, or High Altitude Pulmonary Edema, and HACE, or High Altitude Cerebral Edema. These two conditions are the ones that are life-threatening.

Mild AMS is in itself not life threatening. Most people who ascend to altitude will get some form of AMS. It does not mean you will die. The signs and symptoms of mild AMS are one or more of the following: lethargy, headaches, nausea, vomiting, and disorientation. One can over time acclimatize, and then continue onwards. Different people get it to different degrees. To put mild AMS into proper perspective, here's a link to an AMS page for a hospital in Leadville, Colorado. Leadville is a town with an elevation above 10,000 feet, and as such visitors to the town often get AMS (http://www.svghd.org/home-oxygen). What's my point in giving you this link? People who visit there and get mild forms of AMS are not at death's door and do not need to immediately descend. If a guide sees mild AMS symptoms and encourages clients to continue, then that is probably ok.

HACE is a much more serious condition, and in fact is life threatening. HACE is a condition where fluid collects within the skull and increases pressure in the brain cavity to such a degree that it causes fatal injury to the brain. The signs of HACE are in many cases a progression of those from Mild AMS, but with these key differences:

Change in one's mental state, or ability to think;
Ataxia: this is a loss of muscle co-ordination; it looks very much the same as when someone is very drunk.

If you would like to read an excellent online repository of information about high-altitude sickness, click here: http://www.high-altitude-medicine.com/AMS-medical.html#AMS.

References to printed material regarding altitude illness can be found at the end of this document

The big unanswered question about the Langevin expedition is this, if we are to talk about responsibility and blame: Were these HACE symptoms (not the mild AMS symptoms, the HACE symptoms) visible in Ms. Langevin BEFORE the guide insisted that they descend? If he insisted they descend the instant they became visible, then he cannot be faulted. If he observed these symptoms and did not initially recommend descent (or, even worse, recommended ascent), then he behaved irresponsibly and is at fault.

Now, there are so many similarities between Ms. Langevin's Expedition and ours. So much so, in fact, that it attracts a lot of negative commentary from people who try and compare our two expeditions. However, the similarities also allow us to contrast a relatively normal benign climb with one that went disastrously wrong.

Similarities between the two climbing expeditions:

The climbers of both teams were from Ottawa , Canada
We both used Zara International Travel as our guide company.
Our climbs started on the same day (January 3).
We both stayed at the Springlands hotel the night before the climb (The Springlands hotel is owned by Zara, so if you book with them you get a night before and a night after your climb as part of the package).
We both had 'late' guides on the first day.
The upper-mountain route they were taking was the exact same as ours (the Western Breach). Their climbing route and our climbing route join at the Lava Tower Campsite.

So, what were the differences between our two expeditions?

They took a different route on the lower part of the mountain, coming up what is called the Lemosho route. We came up the Umbwe route. Both our routes merged at the Lava Tower campsite. This difference is likely not very important as a contributory factor.
Their itinerary called for a night camped out in the crater at 18,750 feet, on the fifth night of climbing. Our itinerary saw us finishing our second day of acclimatization at 15,200 feet at Lava Tower on the night of day 5. This means that they had a climb rate that was 45% higher than ours.
Any statement on the differences in experience level and capability between our two groups is speculative. However, from what I have seen written, and what I've learned from the various involved parties, they may have had no real previous high-altitude experience.

So, why did their expedition end in tragedy and ours in success? Was our expedition really on the edge of disaster, just escaping from certain brain-squeezing death by our fingernails?

Well, from the facts that have been presented to me, I can fairly safely make the following statements, the biggest of which is this: their group was ascending without any built-in acclimatization days. They were attempting to make it to the crater rim on the fifth day. That's 2,800 feet (the altitude of Moshi) to 18,750 feet in five days. That is a huge amount of altitude gain with very little acclimatization time. That alone was probably a very big factor in increasing the likelihood of getting HACE. Hopefully someone (their guide, Zara, whoever...) told them that this was a very aggressive climb schedule.

The second statement is more speculative - we do not accurately know the general level of experience this group had with altitude. According to the newspaper article, their training involved peaks no higher than about 5,000 - 6,000 feet - well below where there is any onset of AMS symptoms. If those statements are true, then it may very well be that they may have confused their own symptoms with those of simple effort and fatigue, and ignored them. (Note that I said may. I don't really know for sure).

So, in summary: our climb was not a reckless death-defying adventure. Far, far from it. We really did perform due diligence; we allocated extra time - two full days - for acclimatization. We chose not to camp in the summit crater (which is much higher in altitude than any other camp location). I think I would have added yet another day if we had decided to camp in the crater (for a total of 9). We watched carefully for signs of severe AMS, or worse, signs of the two types of edemas. We had nothing worse than some moderate headaches, some lethargy, some nausea, and two instances of vomiting. In both of those cases, we had a full day of acclimatization, staying at the same campsite, to allow our bodies to adapt. We were cognizant of the need to hydrate, hydrate, hydrate, and keep well fed. In the end, I can't really speak definitively on how precisely things went in the Langevin expedition, but I feel very comfortable with the margin of safety in ours. Climbing a mountain like Kilimanjaro does not have to be excessively dangerous!

I will now turn my attention once again to the guide of their group. Regardless of the level of experience of clients, a guide has a responsibility to look after them, especially so if they are not that experienced with high altitude. Did he check on them often? Did he ask about how they were feeling? Did he try to observe whether their altitude sickness was progressing to a serious degree? And again, did he observe the onset of HACE signs and not immediately recommend descent? I can envision a guide tolerating some signs of mild AMS; those are very common. However, any guide should have, upon seeing the more severe signs mentioned above, insisted on immediate descent. Anything else would be negligent. Did he or didn't he? I honestly don't know and can't tell from what I've read.

There is one interesting paragraph in the citizen article, though:

"Normande kept feeling bad and the guide said she should go down at once"

Now, does this represent the first moment where HACE symptoms became apparent? If so, the guide did the proper thing.

One thing I've not commented on to this point are the actions of the guide after HACE was detected. There are some allegations that the guide did not know how to properly operate his equipment. If that is so, then it likely compounded this whole affair. Additionally, if the part about the guide trying to hit up the group for a tip after the climb is true, then that was unquestionably tactless. Shame on him for that.

What are my final thoughts on this incident? Well, first and foremost, I express my condolences to anyone directly affected by this tragedy. It is my belief that it could have been avoided. The pain that relatives, friends and families must go through is difficult to contemplate. Zara travel has a relatively good reputation in the Kilimanjaro climb industry. This incident will undoubtably put a stain on their reputation, whether or not they were in any way culpable. They should do their utmost to be open and transparent about dealing with situations like this, to prove to everyone that they are willing to learn, and to put client safety first.

At this point in time, I don't really know who is to blame, because I don't know the exact timing and circumstances surrounding the signs and symptoms of illness. I sincerely hope that people can read this and understand that, like most things in life, you need to clearly understand a situation before passing judgement on that situation, or on the "halo" judgment that is often passed on the related activity and anyone who takes part in it (in this case, high-altitude mountaineering). The Citizen article, while in many ways informative, has a number of inconsistencies, errors, and assumptions. These give the reader a false impression of such a climb and of what differentiates a safe situation from an unsafe situation. I find it a bit irritating when someone comes up to me after reading the story of this tragedy and telling me "geez, wooo, you were pretty lucky this didn't happen to you up there!". Well, no. We were NOT just "lucky". We were careful and prudent in both planning and execution and things went well as a result.

Climbing Kilimanjaro can be a wonderful and very achievable adventure. Please, do it safely!

Timelines

For those who wish to pick apart some of my detective work regarding all of this, here is my piecing together of the timelines, as I currently know them:

Date	Our Expedition	Langevin Expedition	Julia and Courtney's expedition	Notes
Day 1 - January 3, 2005 (Monday)	Stayed previous night at Zara's Springlands Hotel in Moshi; departed 3 hours late for Umbwe Gate; Started climb on Umbwe route (entry point - Umbwe Gate). Climbed from Umbwe Gate (5600') to Lower Umbwe Caves (9700')	Stayed previous night at Zara's Springlands Hotel in Moshi; departed 9-10AM hours late for Londorossi Gate; Started climb on Lemosho route (entry point - Londorossi Gate). Climbed from Lemosho Glades (7400;) to Forest Camp (9000')	Unknown; Started climb on Lemosho route (entry point - Londorossi Gate); Started climb on Lemosho route (entry point - Londorossi Gate). Climbed from Lemosho Glades (7400;) to Forest Camp (9000')
Day 2 - January 4, 2005 (Tuesday)	Climbed from Lower Umbwe Caves (9700') to Barranco Campsite (13000')	Climbed from Forest campsite (9000') to Shira 1 Campsite (11500')	Climbed from Forest campsite (9000') to Shira 1 Campsite (11500')
Day 3 - January 5, 2005 (Wednesday)	No change in camp. Acclimatization Day. Did 1000' ascent/descent acclimatization hike.	Climbed from Shira 1 campsite (11500') to Lava Tower campsite (15200')	Climbed from Shira 1 campsite (11500') to Shira 2 campsite (12600')	Julia states that the Langevin party pushed on beyhond the Shira 2 . Simon confirms that party continued past Shira 2 campsite, and continued all the way to lava tower.
Day 4 - January 6, 2005 (Thursday)	Climbed from Barranco Camp (13000') to Lava Tower Camp (15200').	Climbed from Lava Tower campsite to Arrow Glacier Camp (16,100') [Confirmed]	Climbed from Shira 2 campsite (12600') to Lava Tower campsite (15200')
Day 5 - January 7, 2005 (Friday)	No change in camp. Acclimatization day at 15,200'. Did 700' ascent/descent acclimatization hike. NOTE: total average altitude ascent from Moshi on January 3 to this point : +2700 feet per day. (+1500 feet per day above 10,000 feet)	Climbed from Arrow Glacier camp (16,100') to crater floor (18,750') [Confirmed]; HACE incident occurred on evening/overnight of this day (ie night of 7th/8th). NOTE: total average altitude ascent from Moshi on January 3 to this point : +3200 feet per day. (+2200 feet per day above 10,000 feet. This represents a 45% faster ascent rate than either our expedition or Julia and Courtney's)	No change in camp. Acclimatization day at 15,200; NOTE: total average altitude ascent from Moshi on January 3 to this point : +2700 feet per day. (+1500 feet per day above 10,000 feet)	Emergency descent of Ms. Langevin took Barafu descent route (much easier terrain than Western Breach), plus this correlates well with Julia's observation of the Langevin's party's names in the exit register at Mweka gate a few days later. (confirmed by Simon P)
Day 6 - January 8, 2005 (Saturday)	Climbed from Lava Tower camp (15,200') to Arrow Glacier Camp (16,100')	Descended from crater via Barafu route. Walked all the way back down to the Mweka gate, arriving at 10:30 PM at night. (confirmed by Simon P)	Climbed from Lava Tower camp (15,200') to Arrow Glacier Camp (16,100')
Day 7 - January 9, 2005 (Sunday)	Climbed from Arrow Glacier (16,100') to Summit (19,340') via Western Breach. Descent from Summit to Mweka camp (10,100')		Climbed from Arrow Glacier (16,100') to Summit (19,340') via Western Breach. Descent from Summit to Millennium camp (~12,000' ?)
Day 8 - January 10, 2005 (Monday)	Descent from Mweka camp (10,100') to Mweka Gate (5,600')		Descent from Millennium camp (10,100') to Mweka Gate (5,600')	Julia notes exit register at Mweka gate contains names from Langevin party.

References

Merry, Wayne The official wilderness first aid guide, Toronto, Ontario, Canada: McClelland & Stewart, 1997.

Graydon, Don; Hanson, Kurt The freedom of the hills (6th ed), Seattle, WA, USA: The Mountaineers, 1997.

High-altitude medicine guide: http://www.high-altitude-medicine.com/