Some tips to climb the Kili

The Kilimanjaro is the highest mountain in Africa, and known as one of the Seven Summit.

Even if there is no technical issues to face and it could be described as a hike, the high altitude could cause problem and in some case could be fatal.

Every year, approximately 1,000 people are evacuated from the mountain, and approximately 10 deaths are reported. The actual number of deaths is believed to be two to three times higher. The main cause of death is altitude sickness, hypothermia and falling. Everyone climbing Mount Kilimanjaro should be familiar with the symptoms of altitude sickness.

Please be aware that I am not a doctor neither a specialist of the mountain; these are only tips that I could give to friends that would like to climb it.

Weather

I was not so lucky with the weather. It rained all the time, with wind and the visibility was at most 1 meter!

You need to keep in mind that even the perfect Gore-Tex will even not be waterproof in this case… So you would be wet… And at 4000m, it would be really cold!

 

The porters

They are really great, smart and always ready to help! They are doing a really incredible job, carrying all the stuff up to the mountain. Some of them could also experience AMS.

Please be aware that the tip is a good part of their income, so please consider it as a part of your expenses when you are planning it.

They are hiking the mountain with gear that would become wet even after a little rain, they are ready to use their T-shirt to remove the rain inside your tend, they are trying to help you in whatever situation, always smiling.

They are the best experience of the trip! If you would/could give more, please do it. Never less! And if you could give us some of your used gear, they would appreciate it.

Tipping on Kilimanjaro from the trekking group (not per climber):

·  Guides: $20/day/guide

·  Cook: $15/day

·  Porter: $10/day/porter

 

My travel agency

I choose Kilisa travel, really one of the best travel agency I´ve ever met in my travel adventure.

Kilisa Tours and Safaris

Moshi, Tansania

https://kilisatours.com/

+255 717 397 816

Here you could find the reviews on TripAdvisor (https://www.tripadvisor.de/Attraction_Review-g317084-d11884543-Reviews-Kilisa_Tours_Safaris-Moshi_Kilimanjaro_Region.html)

Naik is the young manager; he is really always present. He replies to all of your question quickly, via email, Facebook or WhatsApp.

The service they offer is really top, the price affordable and the safety and professionality everywhere.

They are sustaining the KPAP (https://kiliporters.org/) to improve the working conditions of the porters. We were 2 people and we had 11 people with us; 2 guides, 1 cook, 1 waiter/cook assistant, 7 porters.

The gears provided was ok, and also the sleeping bag were good (the green north face was warmer as the other)

 

INCLUDED IN THE PRICE PACKAGE 

2 Night Hotel accommodation in Moshi, a day before trek and a day after trek

Transportation to and from your selected route

Transfer from Airport to Moshi on arrival and return to airport after climb.

Accommodation in tent

Certified, experienced, English speaking mountain guides

All Tanzanian National Park Fees

Government Climbing Taxes

Climbing permits

All hot Meals prepared by our cook while on Mountain

Guides, Porters and Cook Salaries 

Fair and ethical treatment of Porters

Enough porters to carry your luggage  

Safety Equipment

  • Emergency Oxygen
  • Pulse Oxymeter

Hot drinks at every meal 

Water provided on climb, mineral water for the first day and boiled water every day

Emergency rescue fees

Personal Summit Certificate signed by the National Park and your Guide

PRICE DOES NOT INCLUDE

– Personal items and toiletries

– Tips for guides, porters and cook 

What to bring

Waterproof sacks

2 pair of hiking boots, both Gore-Tex

4 pair of socks

3 Space blanket

1 Trekking Poles, collapsible

1 Waterproof Hard shell Jacket, breathable with hood in Gore-Tex
1 Down Jacket
2 Soft Shell Jacket
4 Long Sleeve Shirt, light-weight
2 Merino shirt

2 Thermic shirt (X-Bionic)
1 – Waterproof Pants side zipper in Gore-Tex
2 – Hiking Pants
1 – Thermic Pants (X-Bionic)

1 Brimmed Hat, for sun protection
1 Knit Hat, for warmth
1 Balaclava, for face coverage

2 pair of gloves in Gore-Tex (1 warm, 1 thin)

1 Gaiters, waterproof

1 Sunglasses

1 Backpack Cover, waterproof
1 Water Bladder (Camelback type, 3 liters with ice protection)
1 Towel, lightweight, quick-dry

1 Sleeping Bag, warm, four seasons* (you could hire it)

1 Head lamp, with extra batteries
1 Duffel bag, 50-90L capacity, for porters to carry your equipment
1 Daypack, 30-35L capacity, for you to carry your personal gear
Other
Toiletries
Prescriptions
Sunscreen
Insect Repellent, containing DEET
First Aid Kit
Hand Sanitizer
Wet Wipes
Electrolytes, powder or tablets
Micropur

Oximeter and daily check up

Your guide would do a daily health assessment (a sort of LLS) in order to understand if your body is acclimatizing in a proper way.

They do have a pulse-oximeter. A pulse oximeter measures oxygen saturation – the oxygen level in your blood – and your pulse rate. The oximeter is placed on a climber’s fingertip. The oximeter uses two beams of light that shine into small blood vessels and capillaries in your finger. The sensor reflects the amount of oxygen in the blood.

Oxygen saturation is a measurement of how much oxygen your blood is carrying as a percentage of the maximum it could carry. Normal blood oxygen levels at sea level are 95-100%.

The more you are getting high, the less this percentage would be.

As altitude increases, oxygen saturations decrease. Proper acclimatization generally brings oxygen saturations higher, which is why these figures typically rise when oxygen saturations are tested after resting overnight. On Kilimanjaro, oxygen saturations percentages are regularly in the 80’s. There are no definitive saturation levels where a client can be declared absolutely safe or at risk. However, when oxygen saturation drops below 80%, the climber should be monitored very closely.

I do suggest to discuss it with your doctor to understand better how to deal with this measurement.

LLSS

The Lake Louise Scoring System (LLSS) was designed to evaluate adults for symptoms of acute mountain sickness (AMS). The system uses an assessment questionnaire and a scorecard to determine whether an individual has no AMS, mild AMS, or severe AMS. (Note that LLSS does not have a category for moderate AMS.)

A diagnosis of AMS is based on the following conditions:

A rise in altitude within the last 4 days (a given on Kilimanjaro)

Presence of a headache

Presence of at least one other symptom

A total score of 3 or more from the questionnaire

Self-Assessment Questionnaire

·        Headache:

o   No headache = 0

o   Mild headache = 1

o   Moderate headache = 2

o   Severe headache = 3

·        Gastrointestinal symptoms:

o   None = 0

o   Poor appetite or nausea = 1

o   Moderate nausea or vomiting = 2

o   Severe nausea or vomiting = 3

·        Fatigue and weakness:

o   Not tired or weak = 0

o   Mild fatigue/weakness = 1 

o   Moderate fatigue/weakness = 2

o   Severe fatigue/weakness = 3

·        Dizziness and lightheadedness:

o   Not dizzy = 0

o   Mild dizziness = 1

o   Moderate dizziness = 2

o   Severe dizziness, incapacitating = 3

·        Difficulty sleeping: 

o   Slept as well as usual = 0

o   Did not sleep as well as usual = 1

o   Woke many times, poor sleep = 2

o   Could not sleep at all = 3

A total score of 3 to 5 indicates mild AMS. A score of 6 or more signifies severe AMS.

The presence of mild AMS is very common and does not necessarily mean that you will need to descend. On the other hand, an assessment of mild AMS does not preclude you from being turned around either.

 

Acute Mountain Sickness (AMS)

The percentage of oxygen in the atmosphere at sea level is about 21%. As altitude increases, the percentage remains the same but the number of oxygen molecules per breath is reduced. At 3600 m there are roughly 40% fewer oxygen molecules per breath so the body must adjust to having less oxygen. Altitude sickness, known as AMS, is caused by the failure of the body to adapt quickly enough to the reduced oxygen at increased altitudes. Altitude sickness can occur in some people as low as 2500m, but serious symptoms do not usually occur until over 3600 m.

Mountain medicine recognizes three altitude categories:

·        High altitude: 1,500 to 3,500 m

·        Very high altitude: 3,500 to 5,500 m

·        Extreme altitude: 5,500 m and above

In the first category, high altitude, AMS and decreased performance is common. In the second category, very high altitude, AMS and decreased performance are expected. And in extreme altitude, humans can function only for short periods of time, with acclimatization. Mount Kilimanjaro’s summit stands at 5895m – in extreme altitude.

At over 3,000 m, more than 75% of climbers will experience at least some form of mild AMS.

There are four factors related to AMS:

·        High Altitude

·        Fast Rate of Ascent

·        High Degree of Exertion

·        Dehydration: this is the reason why it is really important to drink as much as possible (minimum 3-4 liters a day)

The main cause of altitude sickness is going too high (altitude) too quickly (rate of ascent). Given enough time, your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatization and generally takes one to three days at any given altitude. Several changes take place in the body which enable it to cope with decreased oxygen:

·        The depth of respiration increases

·        The body produces more red blood cells to carry oxygen

·        Pressure in pulmonary capillaries is increased, “forcing” blood into parts of the lung which are not normally used when breathing at sea level

·        The body produces more of a particular enzyme that causes the release of oxygen from hemoglobin to the body tissues

Again, AMS is very common at high altitude. It is difficult to determine who may be affected by altitude sickness since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Many people will experience mild AMS during the acclimatization process. The symptoms usually start 12 to 24 hours after arrival at altitude and will normally disappear within 48 hours. The symptoms of Mild AMS include:

·        Headache

·        Loss of appetite, nausea, or vomiting, excessive flatulation

·        Nausea & Dizziness

·        “pins and needles” sensation 

·        Loss of appetite 

·        Fatigue 

·        Shortness of breath

·        Peripheral edema (swelling of hands, feet, and face)

·        Nose bleeding, shortness of breath upon exertion

·        Persistent rapid pulse

·        Disturbed sleep 

·        General feeling of malaise 

Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside as the body acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate. 

While hiking, it is essential that you communicate any symptoms of illness immediately to others on your trip.

The signs and symptoms of Moderate AMS include:

·        Severe headache that is not relieved by medication

·        Nausea and vomiting, increasing weakness and fatigue

·        Shortness of breath 

·        Decreased coordination (ataxia)

Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. It is important to get the person to descend before the ataxia reaches the point where they cannot walk on their own (which would necessitate a stretcher evacuation). Descending only 300 m will result in some improvement, and 24 hours at the lower altitude will result in a significant improvement.

Continuing on to higher altitude while experiencing moderate AMS can lead to death.

Severe AMS results in an increase in the severity of the aforementioned symptoms including:

·        Shortness of breath at rest

·        Inability to walk

·        Decreasing mental status

·        Symptoms similar to bronchitis

·        Persistent dry cough

·        Fever

·        Shortness of breath even when resting

·        Headache that does not respond to analgesics

·        Unsteady gait

·        Gradual loss of consciousness

·        Increased nausea and vomiting

·        Retinal hemorrhage

Severe AMS requires immediate descent of around 600 m to a lower altitude. There are two serious conditions associated with severe altitude sickness; High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. But, when they do occur, it is usually in people going too high too fast or going very high and staying there. In both cases the lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain.

 

High Altitude Pulmonary Edema (HAPE)

HAPE results from fluid buildup in the lungs. This fluid prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and death. Symptoms of HAPE include:

·        Shortness of breath at rest 

·        Tightness in the chest

·        Persistent cough bringing 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 are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent of around 600 m is a necessary life-saving measure. Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment. 

High Altitude Cerebral Edema (HACE)

HACE is the result of the swelling of brain tissue from fluid leakage. Symptoms of HACE include:

·        Headache 

·        Weakness 

·        Disorientation 

·        Loss of co-ordination 

·        Decreasing levels of consciousness

·        Loss of memory 

·        Hallucinations & Psychotic behavior

·        Coma

This condition is rapidly fatal unless the afflicted person experiences immediate descent. Anyone suffering from HACE must be evacuated to a medical facility for follow-up treatment.

Acclimatization Guidelines

The following are recommended to achieving acclimatization:

·        Pre-acclimatize prior to your trip by hiking in a region above 3500m for at least weekends to the prior 6-8 weeks.

·        Ascend Slowly. Your guides will tell you, “Pole, pole” (slowly, slowly) throughout your climb. Because it takes time to acclimatize, your ascension should be slow

·        Do not overexert yourself. Mild exercise may help altitude acclimatization, but strenuous activity may promote HAPE.

·        Take slow deliberate deep breaths.

·        Climb high, sleep low. Climb to a higher altitude during the day, then sleep at a lower altitude at night. Most routes comply with this principle (Lemosho or Machame 7 days for example).

·        Eat enough food and drink enough water while on your climb. It is recommended that you drink from four to five liters of fluid per day. Also, eat a high calorie diet while at altitude, even if your appetite is diminished. 

·        Diamox is good for prevention and treatment of AMS, but check with your doctor as it could lower your blood pressure.

·        Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillizers, sleeping pills and opiates. These further decrease the respiratory drive during sleep resulting in a worsening of altitude sickness. 

·        If you begin to show symptoms of moderate altitude sickness, don’t go higher until symptoms decrease. If symptoms increase, descend.

Treatment

The only reliable treatment, and in many cases the only option available, is to descend. Attempts to treat or stabilize the patient in situ (at altitude) are dangerous unless highly controlled and with good medical facilities. However, the following treatments have been used when the patient’s location and circumstances permit:

       Oxygen may be used for mild to moderate AMS below 3,700 metres. Symptoms abate in 12 to 36 hours without the need to descend.

       For more serious cases of AMS, or where rapid descent is impractical, a Gamow bag, a portable plastic hyperbaric chamber inflated with a foot pump, can be used to reduce the effective altitude by as much as 1,500 m. A Gamow bag is generally used only as an aid to evacuate severe AMS patients, not to treat them at altitude.

       Acetazolamide 250 mg twice daily dosing assists in AMS treatment by quickening altitude acclimatization. A study by the Denali Medical Research Project concluded: “In established cases of acute mountain sickness, treatment with acetazolamide relieves symptoms, improves arterial oxygenation, and prevents further impairment of pulmonary gas exchange.”

       Dexamethasone showed good results for the treatment of HACE

       Two studies in 2012 showed that Ibuprofen 600 milligrams three times daily was effective at decreasing the severity and incidence of AMS; it was not clear if HAPE or HACE was affected.

       Paracetamol (acetaminophen) has also shown to be as good as ibuprofen for altitude sickness

Mild AMS:

       Stop ascending

       Do not do strenuous activity

       Increase hydration

       Paracetamol 500 mg x os

       Promethazine 25-50 mg x os

Moderate-severe AMS:

       Descending at least 500m

       Gamow bag or oxygen if available

       Acetazolamide 250 mg × os every 12 hours

       Dexamethasone 4 mg × os/im every 6 hours

HACE:

       Descending immediately at least 2000m

       Gamow bag or oxygen4-6 l/m, if available

       Dexamethasone 8 mg ev/im immediately, and after 4 mg× os/im every 6 hours

HAPE:

       Descending immediately at least 2000m

       Gamow bag or oxygen4-6 l/m, if available

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