Re: “A Review of Medical Problems in Himalayan Porters” by Dawadi et al.

Dear Editor,

In their article about medical problems of porters in the Himalayas, the authors focus an almost forgotten population that often suffers heavily from medical problems (Dawadi et al., 2020). Unfortunately they did not include a very relevant recent article about the topic in their otherwise brilliant and important review. The data for this review were obtained also in the Solo Khumbu region (Kuhn et al., 2019). Kühn investigated inpatients treated during 1996–2011 in the Khunde Hospital. Usually inpatients show more severe and sometimes life-threatening symptoms, whereas outpatients or persons who treat themselves without seeing a medical facility have minor symptoms. Therefore, some additional information about this group at risk should be given.

The subgroup of Nepalese workers (nearly exclusively porters) in the total of 479 patients included 277 patients (57.8%, of whom 82% were males, 18% were females). It should be mentioned that ∼20% were female, which may indicate that women are a more vulnerable group since obviously only a few are working as porters. As Dawadi et al. have mentioned, many of the porters were lowlanders: the ethnic group was documented in 113 cases (40.8%) with 34.3% belonging to the Rai. Porters suffered more often from trauma than trekkers (17% vs. 7%, p < 0.001). Thirty-two percent of workers were treated for altitude sickness (trekker 64%, p < 0.001) and 7% for severe gastroenteritis (trekker 16%, p < 0.001). Workers showed more severe respiratory infections (13% vs. 3%, p < 0.001).

The number of patients with severe altitude disease was significant in workers as well as in trekkers (45.5%). It should be mentioned that 70 patients had to be evacuated to save their lives and 9 others died. Concerning the goal of Dawadi's article, another result is of special interest: although the number of patients suffering from severe altitude disease, especially high-altitude pulmonary edema and high-altitude cerebral edema, decreased in trekkers, it increased significantly in the group of workers (r = 0.73; p = 0.002).

During our research in the region in 2008, 2009, and 2011, respectively, we observed several situations where the need for medical treatment of porters was completely ignored by trekking groups and foreign guides even when the symptoms were potentially life threatening. This and the data presented by Dawadi et al. and Kühn et al. clearly lead to the following conclusion: do not forget the porters and care for them as you would do for your own comrades!