Staying Healthy and Safe on Kilimanjaro

Coronavirus (COVID-19)

Map Adventure Safari follows the published Standard Operating Procedures issued by Tanzania's Ministry of Natural Resources and Tourism in full. These procedures have two central aims: keeping visitors who arrive in the country from bringing COVID-19 with them, and protecting visitors from catching it while they are here.

We take added care whenever staff deal with clients, and whenever food and gear for climbers are packed, transported, and prepared. Staff wear personal protective equipment, and we also keep the number of staff-to-client contacts down.

Here is what our clients can expect on the mountain:

Visitors will have their temperature checked when they reach the airport, the park gate, and their hotels. Anyone who shows signs or symptoms of COVID-19 upon arriving in Tanzania will be sent to a medical team for further consultation.

Our entire mountain crew wears masks in vehicles, at the park gate, and around camp, and hotel staff wear masks whenever they deal with clients.

Crew members and hotel staff will stay at least three feet (one meter) away from clients. A medical emergency may call for closer contact, however.

Every client must wear a mask in vehicles and in public places, and each person needs to bring their own. Medical masks and non-medical face coverings, such as cloth masks, neck gaiters, and Buffs, are all acceptable.

Keep hand sanitizer on you at all times. Each client is expected to bring their own.

Acute Mountain Sickness (AMS)

Oxygen makes up about 21% of the air at sea level. That share does not change as you climb, but each breath contains fewer oxygen molecules. At 12,000 feet (3,600 m), you get roughly 40% fewer oxygen molecules per breath, so your body has to adjust to working with less. AMS, or altitude sickness, happens when the body cannot adapt fast enough to the thinner air at higher elevations. Some people feel it as low as 8,000 feet, though serious symptoms do not usually show up until above 12,000 feet.

Mountain medicine divides altitude into three categories:

• High altitude: 4,900 to 11,500 ft (1,500 to 3,500 m)
• Very high altitude: 11,500 to 18,000 ft (3,500 to 5,500 m)
• Extreme altitude: 18,000 ft and above (5,500 m and above)

In the first category, high altitude, AMS and reduced performance are common. In the second, very high altitude, both are expected. At extreme altitude, people can function only for short periods, even with acclimatization. The summit of Mount Kilimanjaro, at 19,340 feet, falls in that extreme range.

Above 10,000 feet (3,000 m), more than 75% of climbers will feel at least a mild form of AMS.

Four factors play into AMS:

• High Altitude
• Fast Rate of Ascent
• High Degree of Extention
• Dehydration

The chief cause of altitude sickness is climbing too high (altitude) too fast (rate of ascent). If you give it enough time, your body will adapt to the lower oxygen at any given elevation. That process is called acclimatization, and it generally takes one to three days at each altitude. The body makes several changes so it can cope with less oxygen:

• Breathing becomes deeper
• More red blood cells are produced to carry oxygen
• Pressure rises in the pulmonary capillaries, "forcing" blood into areas of the lung that are not normally used when breathing at sea level
• The body makes more of a particular enzyme that releases oxygen from hemoglobin into the body tissues

Once more, AMS is very common at high altitudes. Predicting who will be affected is hard, because nothing such as age, sex, or physical condition lines up with susceptibility. Plenty of people feel mild AMS while they acclimatize. Symptoms usually begin 12 to 24 hours after arriving at altitude and normally clear up within 48 hours. Mild AMS can bring:

• Headache
• Nausea & Dizziness
• Loss of appetite
• Fatigue
• Shortness of breath
• Disturbed sleep
• A general feeling of malaise

Symptoms tend to be worse at night, when the drive to breathe is lower. Mild AMS does not get in the way of normal activity, and it generally fades as the body acclimatizes. So long as symptoms stay mild and are only a nuisance, you can keep climbing at a moderate pace.

While hiking, it is essential that you tell the people in your group right away about any symptoms of illness.

Moderate AMS shows up as:

• Severe headache that is not relieved by medication
• Nausea and vomiting, along with growing weakness and fatigue
• Shortness of breath
• Decreased coordination (ataxia)

Normal activity becomes difficult, although the person may still manage to walk unaided. At this point only advanced medications or descent can turn things around. The goal is to get the person down before the ataxia gets so bad that they cannot walk by themselves, which would mean a stretcher evacuation. Dropping just 1,000 feet (300 m) brings some improvement, and 24 hours at the lower altitude brings a significant one.

Going higher while suffering moderate AMS can lead to death.

Severe AMS intensifies the symptoms above and adds more, including:

• Shortness of breath at rest
• Inability to walk
• Decreasing mental status
• Fluid build-up in the lungs

Severe AMS calls for an immediate descent of around 2,000 feet (600 m) to a lower altitude. Two serious conditions are tied to severe altitude sickness: High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both are less common, particularly among people who are properly acclimatized. When they do strike, it is usually in people who go too high too fast, or who go very high and stay there. In either case, a lack of oxygen makes fluid leak through the capillary walls into the lungs or the brain.

High Altitude Pulmonary Edema (HAPE)

HAPE comes from fluid building up in the lungs, which blocks effective oxygen exchange. As it worsens, the oxygen level in the bloodstream falls, leading to cyanosis, impaired cerebral function, and death. HAPE symptoms include:

• Shortness of breath at rest
• Tightness in the chest
• Persistent cough that brings up white, watery, or frothy fluid
• Marked fatigue and weakness
• A feeling of impending suffocation at night
• Confusion, and irrational behavior

Confusion and irrational behavior mean not enough oxygen is reaching the brain. With HAPE, descending around 2,000 feet (600 m) right away is a life-saving necessity. Anyone with HAPE must be taken to a medical facility for proper follow-up treatment.

High Altitude Cerebral Edema (HACE)

HACE happens when brain tissue swells because fluid has leaked into it. HACE symptoms include:

• Headache
• Weakness
• Disorientation
• Loss of co-ordination
• Decreasing levels of consciousness
• Loss of memory
• Hallucinations & Psychotic behavior
• Coma

Unless the person descends immediately, this condition quickly turns fatal. Anyone with HACE must be evacuated to a medical facility for follow-up treatment.

Daily Health Checks

Our guides have plenty of experience spotting altitude sickness and handling the problems it causes for climbers. They keep a constant eye on how you are doing, both by watching you and by talking with you, and they run a formal health check twice a day, morning and evening.

Pulse Oximeter

A pulse oximeter reads your oxygen saturation - the level of oxygen in your blood - along with your pulse rate. It clips onto a climber's fingertip and shines two beams of light into the small blood vessels and capillaries there. The sensor picks up how much oxygen the blood is carrying.

Oxygen saturation expresses how much oxygen your blood holds as a percentage of the most it could hold. At sea level, a normal reading is 95-100%.

Saturation drops as altitude rises. Good acclimatization generally pushes it back up, which is why readings usually improve when they are taken after a night of rest. On Kilimanjaro, saturation percentages are regularly in the '80s. No specific level definitively marks a client as absolutely safe or at risk. Even so, when a climber's saturation falls below 80%, we watch that person very closely.

Lake Louise Scoring System

Our guides also use the Lake Louise Scoring System (LLSS) to work out whether you have any altitude sickness symptoms and how serious they are. LLSS is a set of questions built to assess adults for AMS symptoms. Answer them openly, actively, and honestly, and be just as frank with your guide in general. If you feel unwell, do not pretend otherwise, and do not hide your symptoms by saying you are fine. The guide can treat you well only if the information is accurate.

Sometimes a climber simply has to give up the climb. When that happens, the guide will tell you to descend, and it is an order, not a suggestion or a request. The guide's decision is final. Do not try to talk him out of it, or to persuade him with threats or money to let you continue. Your guide wants you to reach the top, but he will not put your health at risk. Respect his decision.

Acclimatization Guidelines

These steps are recommended to help you acclimatize:

• Pre-acclimatize before your trip with a high-altitude training system.
• Ascend Slowly. Throughout the climb, your guides will keep saying "Pole, pole" (slowly, slowly). Acclimatizing takes time, so your ascent should be slow. Rest days help. Taking a day can raise your chances of reaching the top by up to 30%, and it improves your chances of actually enjoying the experience by far more than that.
• Do not overexert yourself. Mild exercise may aid acclimatization, but strenuous activity may bring on HAPE.
• Breathe in slow, deliberate, deep breaths.
• Climb high, sleep low. Go up to a higher altitude during the day, then sleep at a lower one at night. Most routes follow this principle, and extra acclimatization hikes can be added to your itinerary.
• Eat enough and drink enough water on the climb. Four to five liters of fluid per day is the recommendation. Eat a high-calorie diet at altitude too, even when your appetite is low.
• Use Diamox, an FDA-approved drug, to prevent and treat AMS.
• Stay away from tobacco, alcohol, and other depressant drugs, including barbiturates, tranquilizers, sleeping pills, and opiates. They lower the drive to breathe during sleep even further, which makes altitude sickness worse.
• If moderate altitude sickness symptoms appear, do not go any higher until they ease. If they get worse, descend.

Altitude Medication

Diamox (generic name acetazolamide) is an F.D.A. approved drug for preventing and treating AMS. It acidifies the blood, which speeds up breathing and so hastens acclimatization.

Diamox prevents altitude sickness rather than covering up its symptoms. Studies show that a dose of 250 mg every eight to twelve hours, taken before and during a rapid ascent, leads to fewer and/or milder symptoms of acute mountain sickness (AMS).

Keep taking it until you are below the altitude where symptoms began to bother you. Side effects of acetazolamide include tingling or numbness in the fingers, toes, and face, changes in taste, frequent urination, and, rarely, blurred vision. All of these go away once you stop the medicine. Whether to take Diamox as protection against AMS is each climber's personal choice.

Map Adventure Safari neither advocates nor discourages the use of Diamox. Ibuprofen can be used to relieve altitude-induced headaches.

Mountain Rescue

-Bottled Oxygen

As a precaution and an added layer of safety, we bring bottled oxygen on every climb. The canister is for emergencies only. It is NOT used to help clients who have not acclimatized well on their own to climb higher. The fastest treatment for moderate and serious altitude sickness is descent, and on Kilimanjaro's routes it is always possible to go down, and to go down quickly. So oxygen is used strictly to treat a stricken climber, when needed, alongside descent, for moderate and severe altitude sickness.

We know that some operators market personal supplementary oxygen systems as a way to get rid of AMS symptoms. Giving oxygen this way, and for this purpose, is dangerous because it only treats altitude sickness temporarily. Once the oxygen stops, the client is at an even higher altitude without having acclimatized properly.

99% of the companies on Kilimanjaro do NOT offer supplementary oxygen - because it is potentially dangerous, wholly unnecessary and against the spirit of climbing Kilimanjaro. The mountain's challenge lies in the fact that the summit sits at a high elevation, and climbers must adapt to the lower oxygen levels there. Relying on supplementary oxygen is like bringing the mountain down to sea level, where nearly everyone can summit.

-Portable Stretcher

Large rescue stretchers with a single wheel exist on Mount Kilimanjaro, but only on certain routes in the park. So if a climber cannot walk because of severe altitude sickness or a leg injury that limits mobility, getting that person down can be a real challenge for Kilimanjaro operators when no stretcher is nearby. Usually it means helping the injured climber by carrying him or her on someone's back.

On northern routes, Map Adventure Safari carries a portable stretcher for emergencies, for the times when a climber cannot walk and the trekking party is some distance from the park's stretchers.

Our portable stretchers are compact, strong, and lightweight, and they can get an injured climber off the mountain quickly. The climber is strapped onto the stretcher, and porters then hold the handgrips and carry the person to safety.

Kilimanjaro Search and Rescue

We work with Kilimanjaro Search and Rescue (SAR), a helicopter rescue operation that provides modern, efficient rescue services on Kilimanjaro. Airbus AS 350 B3 helicopters wait nearby at Moshi Airport, and once a distress call comes in, rescue procedures kick off within five minutes. The expert pilots, highly trained rescue doctors, and emergency flight technicians are exceptionally qualified and ready for any emergency on the mountain.

Kilimanjaro SAR runs a medical clinic focused on high altitude-related illnesses, mountain medicine, and trauma. Physicians, nurses, and assistants staff it 24 hours a day, offering the best possible treatment. A unique Clinical Advisory Team of top-level medical and high altitude professionals advises the group.

Note that: this service is only available to clients who hold the required travel insurance. To qualify for a Kilimanjaro SAR rescue, clients must be covered to trek at high altitudes up to 6,000 meters. Our staff will verify your travel insurance before the trek.