To the Editor:
We were delighted to read one of the few research articles on Nepali porters in the Mount Everest region. 1 Being from this region, we were particularly interested in reviewing the article meticulously, learning from its findings, and applying the information to our medical practice. While studying the article, we came across some points that we hope the authors will clarify.
The first question relates to the methods and the exclusion criteria for enrollment into the study, which were acute mountain sickness (AMS), diabetes mellitus, glaucoma, epilepsy, or sulphonamide allergy. How were these conditions considered? From history, any medical documentation, drugs the porters had taken, or investigations done at the research site? It appears to us that most Nepalese do not know about these conditions.
The second point is the incidence of AMS found: 11.9%; this is very low in comparison with previous studies. 2 Also, AMS was more common in the people taking acetazolamide than in the placebo group. How can this study, therefore, support that acetazolamide prevents AMS?
The third point for consideration is the dropout rate, which the authors opine was related to the porters’ possible cultural aversion to taking the drugs. Did the authors find any taboo that discouraged the porters from taking the drugs?
Fourth, the study concludes that there was poor compliance with acetazolamide and that its recommendation to Nepali porters was, therefore, impractical. At the same time, however, the authors suggest that nonpharmacological measures, such as adequate rest days and slow ascent rates, would be good recommendations. In our experience, and as the authors mentioned, these porters are there for employment and must wait for the tourists, thus limiting their options regarding rest days and ascent rate. We therefore believe this recommendation is even less practical.
The final point is that better education has resulted in prompt action being taken after the development of symptoms of AMS and high-altitude cerebral edema in trekkers, 3 and research shows that large populations of at-risk, high-altitude travelers are relatively naive to the dangers of altitude sickness. 4 Thus, we believe that better counseling about the dangers of AMS and the importance of taking prophylactic drugs is crucial even in Nepali porters. Were the education and counseling in this study adequate such that the porters fully understood the hazards of AMS and the usefulness of drugs?