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Altitude is the single most important consideration on Kilimanjaro. It is the reason for failed summit bids, emergency evacuations and the general feeling of discomfort most will experience at some time on Kilimanjaro.
The hardest thing about altitude sickness is that it is very difficult to predict who will be affected. Fitness has little impact, in fact fitter types often struggle more as they are more complacent and gain altitude too quickly. More important than how fit you are, is how you climb the mountain…
There is a fairly well established method for reducing the risk of altitude sickness:
#1 Pole Pole or take it easy. There is no two ways about it, you are going to be driven mad by plaintive cries of ‘pole pole’ by guides and porters alike on Kilimanjaro. You’d be wise to heed the advice. Walking at a steady slow pace with plenty of stops gives your body more chance to acclimatize to the altitude and ensures you can keep getting a rich supply of oxygen to your blood. Do not be tempted to try to keep up with the quickest in your group, keep to your own pace.
#2 Drink and eat well. Many of the symptoms of altitude sickness can be confused with dehydration and make diagnosis difficult. Dehydration occurs faster at higher altitudes and results in head-aches. Concentrate on drinking water regularly throughout the day and drink more than you would normally expect (4 litres a day is a good benchmark)
#3 Do what your guide tells you. Guides have been trained to distinguish between dehydration, mild altitude sickness, severe AMS and life threatening High Altitude Cerebral Edema. Your own ability to self-diagnose is severely impaired by the altitude. For this reason it is essential you follow your guide’s advice.
#4 Diamox. Diamox is effective in enhancing the speed of acclimatization and reducing the symptoms of altitude sickness. Its side effects include increased urination which can increase the chances of dehydration. Seek specialist medical advice if you are considering using Diamox.
#5 Climb another high mountain in the lead up to Kilimanjaro. Climbing to high altitudes before attempting Kilimanjaro can make your ascent much easier, giving you sufficient prior acclimatisation to deal with the altitude. The final base camps for Kili are around 4,600m, so you if you have climbed to that altitude within the three months prior to tackling Kilimanjaro, you will have a distinct advantage. Mount Kenya (4,985m), Mount Meru in Tanzania (4,565m), The Simien Mountains in Ethiopia (4,500m) and the more accessible Mount Toubkal in Morocco (4,167m) are all excellent preparation.
Symptoms of mild AMS include headache, nausea, dizziness, shortness of breath, loss of appetite and generally feeling a bit worse for wear. It affects the majority of people above around 3,000m, so the likelihood is everybody will feel some of these symptoms on Kilimanjaro. The symptoms can be alleviated by taking ibuprofen. Mild AMS does not affect your ability to continue up Kilimanjaro, but it certainly doesn’t make it any easier.
Moderate AMS include severe headache that doesn’t go after taking painkillers, vomiting and decreased coordination. The only solution is descent of at least 300m. Trekkers can continue their ascent if symptoms have subsided after 24 hours at the lower altitude.
Severe AMS is a more severe form of moderate AMS that requires immediate descent to an altitude below 1,000m. Staff are trained in rapid evacuation procedures and a trekker can be carried to complete safety rapidly from anywhere on the mountain.
Guides are very experienced and trained in the specialist field of altitude mountain sickness. Medical knowledge of high-altitude physiology is generally poor, so whilst the guides don't have medical degrees, they are trusted to make sensible decisions and be decisive in implementing evacuation procedures where they judge this to be necessary. Due to the sheer number of climbs they have led, they have a vast experience of observing and distinguishing different stages of mountain sickness in addition to specialist knowledge gained in training (required of all qualified guides).