More than 10% of the 900,000 visitors to Nepal last year went trekking. With such a large number on the move, altitude sickness, infections and accidental falls are frequent. Since trekking routes are usually remote, hikers in genuine emergencies are evacuated by helicopters to Kathmandu. Nepal has an advanced rescue network.
Most rescued trekkers are really sick. But it is often difficult to determine whether hikers suffering from Acute Mountain Sickness (AMS) will get better by descending or if they need to be medevaced. Since there is room to fudge it, greed and competition has brought together some private helicopter companies and hospitals to cheat with false claims.
In 1989, there were 75 rescues per 100,000 trekking permits. By 2000 the number had soared to 373 per 100,000. In the past year, there were 3,000 rescues per 100,000 trekkers. (See graph)
“From a medical point of view, the most challenging aspect of helicopter rescues is confirming the need for rescue after the person is back in Kathmandu … the rescue may have been totally legitimate, and yet the patient may have improved dramatically since the moment the rescue was requested,” wrote Prativa Pandey in 2013, in a prescient article for for the Himalayan Rescue Association magazine.“Financial reward for requesting a helicopter rescue could certainly be an added incentive.”
Pandey is a physician at CIWEC, which treats many sick tourists, and says the threshold for heli-evacuation has decreased substantially since domestic aviation was commercialised. Before 1990, all rescues were performed by Royal Nepal Army.
Studies have shown that there has not been an increase in the proportion of trekkers suffering from AMS, but the numbers of rescues of trekkers with altitude sickeness has soared. Most symptoms can be alleviated by descent, while more serious pulmonary or cerebral oedema require emergency rescue.
However, a Nepali Times investigation showed that there are trek leaders who insist on a chopper rescue at the slightest complaint of headache or nausea. Some helicopter companies are partly owned by private hospitals in Kathmandu, and the fake insurance claims are shared, and kickbacks offered.
One trekking agent who helicoptered a genuinely sick client from Khumbu to a well-known private hospital in Kathmandu last year was taken aside and offered an envelope containing Rs150,000 in cash – he was told it was his ‘commission’ for bringing the patient.
This spring, a trekking group leader on Island Peak ordered a helicopter from Kathmandu to evacuate a sick trekker. The pilot brought along 10kg of unsolicited chicken as goodwill payment for the rescue. Trekking groups say such ‘bribes’ are standard operating procedure.
There are horror stories about some trekking guides deliberately making clients sick by contaminating their food. But there are also lazy trekkers who do not want to walk back, so pretend to be sick and are helicoptered out with the active connivance of their agency. Stiff competition, undercutting in the tourism business, and the slim margins for helicopter companies, has made insurance scams too tempting for some to resist.
Private hospitals offering kickbacks to helicopter companies is just an extension of their standard practice of paying ambulance drivers who bring patients to the emergency.
There have been many heroic rescues in the Nepal Himalaya. Airlines have invested in high performance helicopters that can make rescues up to 6,500m. Many hikers and mountaineers would have died if the option were not there. During the 2015 earthquake, 140 climbers were rescued from above the Khumbu Icefall on Mt Everest. In 2010 three Spaniards were winched up by long-line at 6,950m on Annapurna IV.
Such necessary rescues are now in jeopardy because of a few unscrupulous operators. The government, which should regulate the business, has botched its investigation by implicating everyone, but punishing no one.