Tourists travelling to Kilimanjaro do need advice

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7354.46/a (Published 06 July 2002) Cite this as: BMJ 2002;325:46
  1. Stephen Toovey, medical director (toovey{at}travelclinic.co.za),
  2. Andrew Jamieson, medical director
  1. Netcare Travel Clinics, PO Box 786692, Sandton, 2146, South Africa
  2. Netcare Travel Clinics, South Africa and Mozambique, PO Box 573, Sunninghill, 2157, South Africa

    EDITOR—As Bellis's letter confirms, many tourists attempting the ascent of Kilimanjaro come ill prepared for the climb.1 We have treated tourists on the mountain for a range of conditions, including high altitude cerebral and pulmonary oedema. In one instance we chanced on a traveller who was both frankly cyanotic and ataxic at an altitude of 3500 m and treated him with the last spare course of dexamethasone. We insisted that he descend, to the chagrin of his guide, who was encouraging him to continue his ascent. As some guides receive incentives to get tourists to the summit, this type of incident will undoubtedly recur.

    Guides are generally drawn from the local population and have little training in first aid or the emergency management of altitude sickness. A helpful measure might be to set up basic training for guides that encompasses basic first aid and indications for descent. This initiative would, we believe, have to come from the travel industry.

    We support the contention that tour operators and travel agents must issue the necessary warnings. Some tour operators do, providing printed material, referral to a travel clinic, and orientation lectures to travellers before departure; others, however, exercise less responsibility. Unfortunately, there seems to be little enforcement of the common law requirement for tour operators and travel agents to fulfil their admonitory obligations.

    Inquiry at the Kilimanjaro Christian Mission Hospital at the base of Kilimanjaro confirmed that it regularly treats tourists with severe altitude sickness. Until a high profile claim is brought against negligent operators and agents we expect that it will continue to receive such patients. We suspect that the solution to this problem will ultimately come from the legal and not the medical profession.

    Embedded Image

    Tourists travelling to Kilimanjaro are regularly treated for severe altitude sickness



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