Chris Smith is the editor of "Travel at High Altitude" - a highly successful booklet that has been translated into 16 languages. A copy can be downloaded here. Chris is due to speak at the 2019 BMMS Science Day on November 13th and so we caught up with her to ask about assembling the booklet and the impact it has had upon those heading into the mountains. First, we asked Chris to introduce herself,
"Some people reading this will know me, although I am not a medic!
Academically, I studied Environmental Science. Professionally I have had 4 jobs - a teacher of 5 - 13 years olds, Young People's Co-ordinator for Local Agenda 21 in Manchester, Community Team Manager for Groundwork Medway Swale and Park Ranger in Sheffield. I am now retired, but do occasionally teach and examine First Aid Courses.
As a teenager I became involved in Scouting – I am still a Cub Leader. Through Scouting I became involved in Mountain Rescue (2 teams over 25 years) and through Mountain Rescue I became involved in the British Mount Everest Medical Expedition in 1992 as a ‘lay person’ guinea pig. Through BMEME - now Medex - I have helped out with 4 research expeditions, several Plas y Brennin courses and most recently the Hathersage weekends.
I enjoy ‘playing’ outdoors, but am a jack of all trades and master of none – any excuse for a day outside. I have been lucky enough to explore a few amazing mountain areas – in Switzerland, Nepal, India (Ladakh), Peru, Greenland, Spitsbergen, Canada, New Zealand…
I get a headache at about 5,000m – but luckily only for a few hours!
Travel at High Altitude - English Edition.
How would you describe "Travel At High Altitude"?
TAHA is a small, easily portable, clearly laid out booklet written for lay people. It was written to provide everyone who might travel to high altitude (i.e. trekkers, climbers, holiday makers, business people and guides) information on altitude illness and how their body might react.
Was there anything that triggered the writing of it? Where did it all start?
As with many bright ideas (it wasn’t my idea!), there was a conversation in the lounge of the Old Dungeon Ghyll Hotel following the 2005 annual dinner. We were two Environmental Scientists with a feeling that Medex was full of expertise and needed to find a way of sharing it with a wider audience.
The initial idea floated around a coffee table book with a working title of ‘Medex – Health & Heights’ and the chapter headings included; Heights, Health, Research, Environment and People.
The initial idea morphed into ‘Taking Humans to Altitude’. The chapter headings then included; Getting sick at altitude, ‘What’s up Doc’, Getting it right at Altitude and Pills and Potions.
When we spotted a little Lonely Planet ‘Travel Safe’ booklet the design was easily agreed and filling the pages with appropriate information about travel at high altitude then became the challenge.
Parallel to this, I think everyone involved in Medex also had stories to tell of people they had met or situations they had faced. So many people we met seemed to know so little about altitude illness and keeping themselves healthy. We really began to like the idea of providing a simple, easily accessible guide that could help reduce altitude related illness and deaths.
Can you describe the process of putting it all together?
It took about a year to go from a few brain waves to a clear set of aims, a product design and a rationale.
Having agreed on the page headings, we then ‘volunteered’ specialist doctors / medical researchers and asked them to provide us with 300 words maximum – written in plain English for an 11 year old reader. We also asked for photos, case studies and the ‘before you go’ / ‘at altitude’ advice. There are 37 names on the original credits page - my role was definitely that of ‘nag bag’ - chivvying people for contributions!
The returned information was ‘language checked’ and fitted into the space available by Denzil Broadhurst (Medex / Oldham MRT).
The final product was scrutinised by 3 medical editors - Simon Currin, David Hillebrandt and Jim Milledge.
With the website in its infancy, we printed 7,000 copies and posted them and handed them to everyone we could think of - travel clinics, the press, trekking agents, outdoor magazines, etc.
However website downloads have been our method of circulation for the last 10 years.
Excitingly we are in the process of developing a ‘Medex App’ which will, amongst other things, make the booklet even more readily available.
What were the greatest challenges?
Reading what the doctors had written!
It was quite difficult asking very busy people to provide us with what we wanted – something short and simple - especially when it is their lifetime's work and passion.
It was also hard to get the balance right – simple, with the right information, for a mixed audience and not too scary.
What advice would you give to someone starting on a similar project?
Let the vision evolve naturally, have plenty of time on your hands and people around you to provide expert support. Then have some amazing people around you to promote the final product.
What feedback have you received?
The feedback has been beyond all our wildest dreams! It is recommended by the BMG, BMC and UIAA and used by those following Diploma in Mountain Medicine courses. We know some travel companies in the UK also recommend it. Everyone has been really positive – medics and non medics alike.
What never ceases to amaze me is that 12 years on it is still held up as a useful booklet to share and new translations are still being offered.
Another positive, beyond our initial vision, is that it is being translated and used to help educate local employers and employees – helping them to understand their own health and that of their clients.
Travel at High Altitude is now available in Swahili.
How about the translations? How many does it run to now?
The booklet is now available in 16 different languages and has several others which might yet come to fruition. We have set guidelines for those translating – just to make sure the remit is clear. I don’t think many of those who volunteer to translate the booklet realise just how difficult it is to do. Denzil does an amazing job of making things fit. Only the Persian version was done without our input – which is why it isn’t quite the same (it’s a right to left language and the Kanchenjunga cover photo is back to front!).
We are very excited that we have finally got a Swahili version. Hopefully that will be available to the local staff working on Kilimanjaro. The Nepali version (without the ‘offensive’ bare chest photo) has been used on training courses in Nepal. Hopefully one day soon the Swahili version will become equally valued.
The short cases included in the book really bring the information to life. Is there one that stands out for you?
Probably the hardest question to answer! Am I permitted to mention 5 case studies and 1 photo?
2 make me grin because they are my stories – it was my BP that went sky high and it was me who had the hourly peeing tent mate. Ironically it’s me that has to get up regularly at night to pee 25 years on!
The Jungfraujoch is a glacial saddle that connects two 4000m peaks - the Monch and the Jungfrau. It can be accessed by train and has Europe's highest railway station at 3572m. Passengers are therefore particularly prone to Acute Mountain Sickness (AMS)!
1 makes me realise that we still don’t share our knowledge enough. It was my nephew who got AMS on the Jungfraujoch. Our family has been to Switzerland many times – with no knowledge of AMS. Once I did know, it never occurred to me to tell my sister about it.
The last 2 are incidents which I was involved in – HACE on Everest and anaphylaxis. Both were frightening, but had happy endings because we travelled at altitude with some very talented medics.
The most emotive page in the book is the photo George sitting with one of the locals on our first research expedition to Everest in 1994. George's daughter lost her life whilst on her honeymoon at altitude. He became a great supporter and came to help with the research so that more people could find out about altitude illness.
Has it turned out how you expected it to?
If I look back to the conversation about the coffee table book full of spectacular scenery and wildlife photos, then the answer is no.
If I think about wanting to produce an easy guide to altitude which anyone can read, then yes.
Is there anything you wish you'd included?
No. I am comfortable that we got the balance about right.
We have had discussions recently about whether there is a need to review / revise it and there are a few ideas for change – but there certainly doesn’t seem to be a ground swell of opinion to do anything yet.
Do you have any idea how many people have seen it?
Absolutely no idea!
Medex web hits (24/01/2008 - 24/08/2019) = 162,705, Booklet hits 46,705, with over 27,000 English downloads.
Plus the original 7,000 we printed in English and whatever has been printed in other languages.
What I do know is that there are a huge number of people who still haven’t seen it. On every expedition we have become involved with travellers and local staff who have fallen ill – many with what were probably preventable altitude related illnesses. The medics in the team have provided life saving interventions (be that advice or medical intervention) – I sometimes get to do the TLC. So clearly we still haven’t completed the challenge of getting information to the people who need it.
I do wonder how many people (climbers and guides) in the infamous ‘Everest’ 2019 queue or those taking part in the BBC Kilimanjaro Climb for Comic Relief had seen the booklet???
Was it always important to keep it free?
Yes. We did originally consider trying to publish and sell it or get it adopted by a publisher, but we didn’t like the logistics. The more the project developed the more we wanted to make it accessible to anyone and everyone. I really think that was the right decision. At the end of the day we wanted to help people avoid altitude illness and maybe save lives.
Thanks Chris for speaking to us!
Further information about the 2019 BMMS Science Day can be found here.