The Telegraph
Since 1st March, 1999
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Siachen legacy: medics turn altitude specialists

Hunder (Nubra Valley), Nov. 5 (Reuters): Lance Corporal D.B. Pun was posted far up on the Siachen glacier, the world’s highest battlefield, when he began getting headaches. Soon he was unconscious and being flown out on a helicopter.

A victim of high altitude pulmonary oedema, he was evacuated from his post at 16,000 feet and flown to a specialist military hospital near the town of Hunder in the remote Nubra Valley in northwest India.

In the almost 20 years in which India has been fighting Pakistan for control of the glacier, Indian doctors have become world specialists on high-altitude medicine, an area more often applied to mountaineers rather than soldiers.

High altitude sicknesses — caused by lack of oxygen — are relatively rare and therefore still not fully understood.

But the Siachen conflict has fuelled a large programme of research in the country — from whether some people are genetically more immune, to trying out new treatments — including sildenafil, better known by its brand name Viagra — on the high altitude oedema sufferers.

When the battle began in 1984 for control of the Siachen glacier — in an uninhabitable wasteland of ice and rock between India, Pakistan and China — troops were airlifted in and ordered to fight their way up to take strategic heights.

Many died in the early years, some from high altitude sicknesses, others from the extreme weather, avalanches, or frostbite.

Over the years, the two nuclear-armed powers dug themselves into an impasse, neither trusting the other enough to withdraw.

But they have also become experts in surviving on one of the most inhospitable battlefields in military history.

Ninety-seven per cent of casualties here are due to the extreme weather and altitude, rather than fighting.

“On the glacier you have to first survive the elements and then you fight the enemy,” says a senior officer.

Drawing on the experience of mountaineers, Indian doctors have prepared a strict schedule for troops, who go through three stages of acclimatisation, each at a higher altitude.

But for forward positions above 18,000 feet, no acclimatisation is possible — the body steadily deteriorates through the three months of deployment at these heights.

For those who do fall sick, the best treatment is to get down quickly, and the only way down quickly is by helicopter.

All forward posts have Hapo (high altitude pulmonary oedema) bags — similar to a sleeping bag — with slits to see through, zipped at the front and sealed so the air pressure inside can be pumped up to simulate lower altitudes.

For anyone with the slightest trace of claustrophobia, it is hard to imagine a more terrifying life-saver than a pulmonary oedema bag.

“You do feel like you are in a coffin,” said a doctor who tried it once for 15 minutes to understand his patients better.

The hospital at Hunder also has its own bigger decompression chamber, similar to those used by deep-sea divers.

It is worse in winter. Frostbite and high altitude sicknesses are more common as the severe cold constricts the blood supply.

“My bed occupancy goes up to 130 to 140 per cent in winter. The average is 70 per cent,” says colonel Dr S.K. Dhingra, commanding officer of the hospital.

At the military hospital in Leh, the main city in the area, doctors have been working for more than 13 years both to find treatments for pulmonary oedema and to work out why some people are more susceptible than others to high altitude.

Indian doctors are credited with establishing that inhaling nitric oxide can help treat pulmonary oedema and are now pioneering research in using Viagra, which offsets the constriction of blood vessels.

The hospital’s High Altitude Medical Research Centre has also found that people living in high regions tend to be physiologically better adapted to extreme altitude, though second-generation Tibetans living in India fare no better than lowlanders.

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