Professor Ewan B Macdonald,University of Glasgow

Shrijana Shrestha, MPH Kathmandu, Nepal

A Survey of the Occupational Health and Safety Needs of High Altitude Mountain

Guides (Sherpas) in Nepal

• Population - 23,151,423 (Census 2001)

• Ethnic Groups - 103

• Languages - 115

• Sherpa - Eastern people, migrated fromTibet 500 years ago

• Sherpas - Himalayan Region,High altitude agriculture andtourism-trekking and climbing

General Health Situation of Nepal

• IMR 48 deaths per 1000 live births• MMR 281 deaths per 100000 live

births• Average Life expectancy 60.4 years• Immunization 83% children of 12-23 months• Top ten Diseases Skin Diseases

Acute Respiratory Infections Diarrhoeal Diseases Gastritis Intestinal WormsPyrexia of Unknown OriginEar Infection Chronic Bronchitis Sore Eye and Eye Complaints Toothache and Oral Complaints

Occupational Health and Safety – Not a priority, no system

High altitude workers• Porters - 30,000 who go to 5000metres

• High altitude porters and

• High altitude climbing guides 4500 - 5000

• Mainly 2 climbing seasons – April to June and October to December

• Hierarchy of Workers – many castes of whichSherpas are the largest group

Kitchen helpers

Cooks

Porters

Trekking Guides

Climbing Guides

Senior Climbing guides

‘Sirdaars’

Objectives

To identify -• health problems they have had as a result of

their work,• any general health problems they have had

• the effect these problems have had on their ability to work

• whether they have been offered any occupational health advice

• opportunities for health promotion advice

• potential intervention strategies to improve their health at work

                                                                                                                             

                                                                                                                                                                                                                                      

Results

• Male 130 Female 1

• Age 20-51 Mean 31 years

• Dependants min 0 max 13 mean 3.2

• Age started employment. Min 7years Max 43 Mean 20 years

Results-Work Related

• Respiratory problems 66 (50.4%)• Back Pain 52 (39.7%)• Joint Pain 37 (28.2%)• Chest Problem 35 (26.7%)• Abdominal pain 34 (26%)• Eye Problems 27 (20.6%)• Leg Pain 26 (19.8%)• Mental Problem 8 (6.1%)

Results-Work Related

• 19 Sherpas – No Health Problems

• 73 Sherpas – 1 to 3 Health Problems

• 38 Sherpas - 4 to 7 Health problems

• Back Pain -significantly associated with working over 12years

General Health Problems

• General Health Good 76, Fairly good 53, Not good 2

• Jaundice 12• Gastric 11• Musculo-skeletal 10• Tuberculosis 3• Chest pain 2• Typhoid 1

Accidents – life time prevalence -25%

• Fall 19• Frostbite 5• Motorbike 3• Bicycle 2• Avalanche 2• Leg fracture 1• Dislocation 1

Lifestyle

• Smoking 21

• Drinking 94 (68 occasional)

• Drugs or any 3 ‘Khaini’

Other chewing tobacco

Conclusion

• High level of morbidity attributed to work

• High level of respiratory complaints confirmed focus group discussion; infections and recurrent coughs

• Musculo-skeletal problems were anticipated

• No systematic occupational health advice available

• Lack of data on occupational cohort• No systematic data collection

• Further research is needed in this and other occupational groups in Nepal

Thank You!