Reflections on Kilimanjaro
My recent trip to Africa began in 1998. Partly as a result of wanderlust and partly due to my relative youth and good health, the time to go seemed right; so I started making arrangements to depart that fall. Tragically, the United States embassies in Dar es Salaam, Tanzania and Nairobi, Kenya were bombed by terrorists on August 7 that year resulting in hundreds of people killed. A subsequent travel advisory issued by the state department recommended that all unnecessary travel to those countries be postponed.
Africa is huge. It is second only to Asia in land mass and population. Most major countries, including the entire continent of Europe can fit within its borders. There are currently 54 sovereign nations in Africa, from which spans the entire political and economic spectrum. Extreme poverty, despotism, genocide as well as unimaginable wealth and true democracy may be found.
Mount Kilimanjaro, located in the Republic of Tanzania, evokes a plethora of images and thoughts. Its legendary snow-capped peak in the equatorial region of the planet invited skepticism among early European explorers before eyewitness accounts confirmed this for their countrymen. Even the name is mysterious, a common translation being “great mountain”. At 19,340 feet, it is the highest freestanding mountain on earth. Other peaks may be higher, but are part of a chain of mountains.
Because of the altitude, it takes many days to reach the summit. In doing so, the trekker passes through five distinct climate zones including a savannah, rain forest, open moorland, the alpine desert, and mountain zone. Traveling through each zone brings cooler temperatures and less oxygen. So while climbing the mountain is not technically difficult, one needs to be in reasonably fit physical condition to continue ascending through rugged terrain.
I am often asked to describe the most difficult part of the trip. Without hesitation, I would say it is the altitude. As I ascended up the mountain, I am constantly reminded of the effects of hypoxia on my body. This is manifest mainly through an increasingly uncomfortable sense of breathlessness and fatigue with even the slightest of exertion. I first noticed this when merely tying my shoelaces caused me to double my respiratory rate.
Medically, there are three degrees of altitude: low altitude from sea level to 1,500 m (4,950 ft), moderate altitude from 1,500-2,500 m (4,950-8,250 ft), and high altitude >2,500 m (8,250 ft). At heights above 2,500 m, cardiopulmonary performance starts to become affected. The partial pressure of oxygen is approximately 60 mmHg, compared to 98 mmHg at sea level. While the altitude itself stimulates physiologic changes in the body, the degree to which these changes occur depend on the rate of ascent, level of acclimatization, exercise intensity, genetics, and age. Maintaining adequate hydration and nutrition are also factors that contribute to the body’s adaptation to high altitudes.
One measure of the amount of oxygen available for use within the body is arterial oxygen saturation (SaO2). At sea level, SaO2 is 98%-100%. Compare that to an unacclimatized person at 4,300 m (14,190 ft), the SaO2 falls to 80% at a partial pressure of oxygen of 40 mmHg. My group of three trekkers had SaO2 measured daily, with a final measurement at 15,300 ft. At this altitude, our SaO2 ranged between 60%-85%. It has been said that if a person at sea level were transported immediately to the top of Mt. Kilimanjaro, he or she would immediately pass out due to hypoxia.
The cardiorespiratory system is profoundly affected by acute exposure to high altitude. In an attempt to get more oxygen into the lungs, minute-volume (the amount of air inhaled or exhaled in one minute) is increased via increasing respiratory rate and inspiratory volume. In other words, you’re breathing faster and taking deeper breaths. In spite of this, there is still a lower amount of oxygen in the blood circulating through the body. The resting heart rate therefore also increases 10%-30% as a response in order to increase the cardiac output.
Other physiologic changes include a reduction of plasma volume secondary to respiratory, urinary, and cutaneous losses, suppression of parasympathetic and augmentation of sympathetic nervous activities, increased metabolic rate with increased glucose utilization and resultant blood lactate levels. All the above-mentioned reactions serve to amplify the stresses to the body that would not normally occur even with strenuous activity that is limited to sea level.
Finally, acute mountain sickness (AMS) or altitude sickness is a known complication of activities in high elevations. Symptoms include headache, fatigue, nausea, vomiting, dizziness, muscular dis-coordination, sleep disturbances. The most serious manifestation of acute mountain sickness, high altitude pulmonary edema (HAPE), is a life-threatening noncardiogenic pulmonary edema that typically occurs within 4 days of exposure to high elevation. The definitive treatment is immediate descent and administration of supplemental oxygen. While a number of pharmacologic interventions have been reported to ameliorate the effects of high altitude, none have been consistently successful although acetazolamide (Diamox) is the most frequently used preventive medication by mountain climbers.
My trek to the summit of Mt. Kilimanjaro took seven days – 5 to reach the top and 2 to descend. While there are a number of different routes to the top, the one I took (Umbwe route) is the fastest and considered the most difficult. We slept in tents on uneven surface. All provisions were backpacked in. Water was scarce and required porters hired specifically to carry containers to our campsites.
The guides and porters in my group were extremely friendly and helpful. They took a personal interest in our safety and enjoyment. I was amazed by the amount of physical exertion each of them spent during the course of my trip. This has to be one of the most physically demanding jobs there is.
The flora and fauna on the mountain created an otherworldly experience. A variety of plants not found anywhere else on the planet are seen in great quantity. It rained or snowed briefly everyday, but the skies also cleared enough so that we were treated to spectacular sunsets and vistas. The night sky was decorated with thousands of stars. At the time of my trip, Jupiter was the brightest object overhead.
The day we were scheduled to summit began at midnight of the fifth day. This is the most difficult portion of the journey. We packed our daypacks and ate breakfast using flashlights. As we started climbing at 1:00 AM, the only visible objects seen are those illuminated from a small spot of light coming from our headlamps. This is actually a blessing as we were not able to see the steepness and drop-offs from narrow ledges in parts of trail to the top.
After a few hours, I developed an irresistible urge to fall asleep. The spotlight from my lamp acted as a hypnotic, exacerbating my fatigue and dyspnea. I marched on, goaded by encouraging and sometimes forceful words from the head guide – all meant to draw on my rapidly diminishing reserves of energy and determination. Just when I thought there was nothing left in me, someone in our group pointed toward the eastern sky, which had become barely perceptibly lighter. The knowledge that dawn was imminent was enough to refresh my mental state and allow me to continue upward.
I finally reached the peak at 7:30 AM, but not without some nausea, dry heaves, headache, and dizziness. After a brief round of congratulations and photo ops, we started our descent. We stopped at our camp for a quick lunch and moved on to the next campsite, arriving just before sunset at 6:30 PM. Our 18-hour day had finally finished. I was asleep even before my head hit the ground. We hiked out of the mountain the next morning and reached our lodge in the early afternoon, where I took my first shower in a week.
My time in Africa is the trip of a lifetime. I experienced and saw some of most beautiful sights in this world. I was also privileged to meet with some Tanzanians who despite their lack of material wealth demonstrated a hospitality and graciousness amidst difficult life circumstances. They shared some of their dreams and aspirations with me, which I hope would come true for them and their families.
The following week, I embarked on a safari. But that’s another story …