Fitness

There’s no need to go overboard with fitness preparations for climbing Kili. The main reason why people fail to reach the summit is due to altitude sickness rather than lack of necessary strength or stamina. That said, the trek will obviously be more enjoyable for you the fitter you are, so anything you can do in the way of training can only help.

A weekend of walking would be a good thing to do; it won’t improve your fitness to a great degree, but it will at least confirm that you can walk for more than a few hours, and for more one day. Wear the clothes you plan to bring to Kilimanjaro with you - particularly your boots and socks - and carry the daypack that you hope to be carrying all the way to the top of Kibo too.

Inoculations

The only vaccination that you must have to enter Tanzania is yellow fever. Remember to collect a health card or some other written evidence from your doctor to prove you’ve had the jab. Sort out your vaccinations a few months before you’re due to fly.


Recommended inoculations include:

Typhoid
This disease is caught from contaminated food and water. There are a number of alternative inoculations; the most common lasts for ten years though is said to offer only 50% protection.

Polio    
The polio vaccine is usually administered by sugar-lump, making it one of the more pleasant inoculations.

Hepatitis A
This debilitating disease of the liver is spread by contaminated water, or even by using cutlery that has been washed in this water. The latest inoculations involve two injections adminstered one month apart and cover you for ten years.

Meningitis  
This disease of the brain is often fatal, though the vaccination, while not free, is safe and effective and should be obtained.

Rabies    
If you’re spending some time with animals or in the wilderness, it’s also worth considering having a course of rabies injections.

Tetanus
Tetanus vaccinations last for ten years and are absolutely vital for visitors to Tanzania. The vaccination is usually given in combination with one for diphtheria.

Malaria
Malaria is a problem in Tanzania, which is considered one of the highest risk countries in the world. While you are highly unlikely to contract malaria on Kilimanjaro, which is too high and cold for the anopheles mosquito (the species that carries malaria), it is rife in coastal areas and on Zanzibar.

When beginning a course of anti-malarials, it is very important to begin taking them before you go; that way the drug is established in your system by the time you set foot on Tanzanian soil, and it will give you a chance to see if the drug is going to cause a reaction or allergy. Once started, complete the full course, which usually runs for several weeks after you return home.

Which anti-malarial you will need depends on which parts of Africa you are visiting and your previous medical history. Your doctor will be able to advise you on what drug is best for you. With Tanzania in the highest risk category, the chances are you will be recommended either Lariam, Doxycycline or the new drug Malarone.

Stories of Lariam causing hallucinations, nightmares, blindness and even death have been doing the rounds in travellers’ circles for years now; but if you feel no adverse reaction to taking them - and millions don’t - carry on and don’t worry.

Of course the best way to combat malaria is not to get bitten at all. A repellent with 30% Diethyltoluamide (DEBT) in the evenings when the malarial anopheles mosquito is active should be effective in preventing bites. Some use it during the day too, when mosquitoes that carry yellow and dengue fevers are active.

Alternatively, you could just keep covered up with long sleeve shirts and long trousers, sleep under a mosquito net and burn mosquito coils; these are available within Tanzania.

Safe trekking

Because of the number of trekkers who scale Kilimanjaro each year, and the odd ways in which some of them choose to do so, many people are under the mistaken impression that Africa’s highest mountain is also a safe mountain. Unfortunately, as any mountaineer will tell you, there’s no such thing as a safe mountain, particularly one nearly 6000m tall with extremes of climate near the summit and ferociously carnivorous animals roaming the lower slopes.
Your biggest enemy on Kilimanjaro, however, is likely to be neither the weather nor the wildlife but the altitude. Unsurprisingly, KINAPA are shy about revealing how many trekkers perish on Kili each year but what is known is that, during the millennium celebrations, when the mountain was swamped by more than a thousand trekkers on New Year’s Eve alone, three died and thirty-three more had to be rescued. The culprit behind at least one of the fatalities was the condition known as acute mountain sickness, or AMS.
The authorities are doing what they can to minimize the number of deaths: guides are given thorough training in what to do if one of their group is showing signs of AMS and trekkers are required to register each night upon arrival at the campsite and have to pay a US$20 ‘rescue fee’ as part of their park fees. But you too can do your bit, by avoiding AMS in the first place.

High altitude travel

The most likely illness you are going to suffer from is altitude sickness; indeed, it’s a rare trekker on Kilimanjaro who doesn’t in some degree. Altitude sickness is caused by the body’s inability to adapt quickly enough to the thinner mountain air present at high altitudes. It can be fatal if ignored or left untreated but is also entirely preventable.

Before you go, if you suffer from heart or lung problems, high blood pressure or are pregnant, you must visit your doctor to get advice on the wisdom of climbing up Africa’s highest mountain; many of the deaths on the mountain are due to heart failure.

AMS

At Uhuru Peak, the summit of Kilimanjaro, the oxygen present in the atmosphere is only half that found at sea level. In other words, every time you breathe on Kibo, you are taking in only half as much oxygen as you would if you took the same breath in Dar es Salaam.

This can, of course, be seriously detrimental to your health; oxygen is, after all, pretty essential to your physical well-being. All of your vital organs need it, as do your muscles. They receive their oxygen via red blood cells, which are loaded with oxygen by your lungs and then pumped around your body by your heart, delivering oxygen as they go.

Problems arise at altitude when that most vital of organs, the brain, isn’t getting enough oxygen and malfunctions as a result; because as the body’s central control room, if the brain malfunctions, so does the rest of you, often with fatal consequences.

Fortunately, your body is an adaptable piece of machinery and can adjust to the lower levels of oxygen present at altitude. Unconsciously you will start to breathe deeper and faster, your blood will thicken as your body produces more red blood cells, and your heart will beat faster.

As a result, your essential organs will receive the same level of oxygen as they always did. But your body needs time before it can effect all these changes. Though the deeper, faster breathing and heart-quickening happen almost as soon as your body realizes that there is less oxygen available, it takes a few days for the blood to thicken.

And with Kilimanjaro, of course, a few days is usually all you have on the mountain, and the changes may simply not happen in time. The result, is AMS.

AMS, or acute mountain sickness (also known as altitude sickness), is what happens when the body fails to adapt in time to the lack of oxygen at altitude.

There are three levels of AMS: mild, moderate and severe. On Kilimanjaro, it’s fair to say that most people will get some symptoms of the illness and will fall into the mild-to-moderate categories. Having symptoms of mild AMS is not necessarily a sign that the sufferer should give up climbing Kili and descend immediately.

Indeed, most or all of the symptoms suffered by those with mild AMS will disappear if the person rests and ascends no further, and assuming the recovery is complete, the assault on the summit can continue. The same goes for moderate AMS too, though here the poor individual and his or her symptoms should be monitored far more closely to ensure that they are not getting any worse and developing into severe AMS.

This is a lot more serious and sufferers with severe AMS should always descend immediately, even if it means going down by torchlight in the middle of the night.

The symptoms of AMS

The symptoms of mild AMS are not dissimilar to the symptoms of a particularly vicious hangover, namely a thumping headache, nausea and a general feel­ing of lousiness. An AMS headache is generally agreed to be one of the most dreadful headaches you can get, a blinding pain that thuds continuously at ever decreasing intervals; only those who have bungee-jumped from a 99ft building with a 100ft elasticated rope will know the intense, repetitive pain AMS can cause. Thankfully, the usual headache remedies should prove effective against a mild AMS headache.

As with a hangover, mild AMS sufferers often have trouble sleeping and, when they do, that sleep can be light and intermittent. They can also suffer from a lack of appetite. Given the energy you’ve expended getting to altitude in the first place, both of these symptoms can seem surprising if you’re not aware of AMS.

Moderate AMS is more serious and requires careful monitoring of the sufferer to ensure that it does not progress to severe AMS. With moderate AMS, the sufferer’s nausea will lead to vomiting, the headache will not go away even after pain-relief remedies, and in addition the sufferer will appear to be perma­nently out of breath, even when doing nothing.

With moderate AMS, it is possible to continue to the summit, but only after a prolonged period of relaxation that will enable the sufferer to make a complete recovery. Unfortunately, treks run to tight schedules and cannot change their itineraries mid-trek. Whether you, as a victim of moderate AMS, will be given time to recover will depend largely upon how fortunate you are, and whether the onset of your illness happens to coincide with a scheduled rest day or not.

With severe AMS, on the other hand, there should be no debate about whether or not to continue; if anybody is showing symptoms of severe AMS it is imperative that they descend immediately. These symptoms include a lack of coordination and balance, a symptom known as ataxia. A quick and easy way to check for ataxia is to draw a 10m line in the sand and ask the person to walk along it.

If they clearly struggle to complete this simple test, suspect ataxia and descend. (Note, however, that ataxia can also be caused by hypothermia or extreme fatigue. As such, ensure that the sufferer is suitably dressed in warm clothing and has eaten well before ascertaining whether or not he or she is suf­fering from ataxia, and what to do about it).

Other symptoms of severe AMS include mental confusion, slurred or incoherent speech, and an inability to stay awake. There may also be a gurgling, liquid sound in the lungs combined with a persistent watery cough which may produce a clear liquid, a pinky phlegm or possibly even blood. There may also be a marked blueness around the face and lips, and a heartbeat that, even at rest, may be over 130 beats per minute.

How to avoid AMS

AMS is easily avoided. The only surefire way to to do is to take your time. Opting to save money by climbing the mountain as quickly as possible is a false economy: the chances are you will have to turn back because of AMS, and all your efforts (and money) will be wasted.

According to the Expedition Advisory Committee at the Royal Geographical Society, the recommended acclimatization period for any altitude greater than 2500m is to sleep no more than 300m higher than your previous night’s camp, and to spend an extra night at every third camp.

But if you were to follow this on the Kilimanjaro’s Marangu Route, for example, from Mandara Huts you would have to take a further eight nights in order to safely adjust to the Kibo Huts’ altitude of 4700m - whereas most trekkers take just two days to walk between the two.

The EAC realize that the short distances and high per diem cost of climbing Kilimanjaro make this lengthy itinerary impractical, so instead they recommend a pre-trek acclimatization walk on Mount Meru or Mount Kenya (4895m to Point Lenana). This is an excellent idea if you have the time and are feeling fit, and providing you do one of these walks immediately before you climb Kili, these treks can be beneficial - and the views towards Kilimanjaro from Meru are delightful too.

But what if you don’t have the time or money to do these other climbs? The answer is to plan your walk on Kilimanjaro as carefully as possible. If you have enough money for a ‘rest day’ or two, take them. These ‘rest days’ are not actually days of rest at all - on the Marangu trail, for example, guides usually lead their trekkers up from Horombo Huts to the Mawenzi Hut at 4600m before returning that same afternoon. But they do provide trekkers with the chance to experience a higher altitude before returning to below 3000-4000m again, thereby obeying the mountaineers’ old maxim about the need to ‘climb high, sleep low’ to avoid mountain sickness.

The route you take is also important. Some of the routes - the Machame, Lemosho and Shira trails via the Barafu Huts, for example - obey the mountaineers’ maxim on the third or fourth days, when the trail climbs to 4530m before plunging down to an altitude of 3950m at Barranco Camp where you spend the night.

Some of the shorter trails, however, do not: for example, it is possible for a trekker walking at an average pace on the Marangu or Rongai trails to reach the Kibo Huts in three days and attempt an assault on the summit for that third night.

This sort of schedule is entirely too rapid, allowing insufficient time for trekkers to adapt to the new conditions prevalent at the higher altitude. This is why the majority of people fail on these trails, and it is also the reason why it is imperative that you take a ‘rest day’ on the way up: to give your body more time to acclimatize.

How you approach the walk is important too. Statistically, men are more likely to suffer from AMS than women, with young men the most vulnerable. The reason is obvious. The competitive streak in most young men causes them to walk faster than the group; that, and the mistaken belief that greater fitness and strength (which most men, mistakenly or otherwise, believe they have) will protect them against AMS.

But AMS is no respecter of fitness or health. Indeed, many experienced mountaineers believe the reverse is true: the less fit you are, the slower you will want to walk, and thus the greater chance you have of acclimatizing properly. The best advice, then, is to go as slowly as possible.

Let your guide be the pacemaker: do not be tempted to hare off ahead of him, but stick with him. That way you can keep a sensible pace - and, what’s more, can ask him any questions about the mountain that occur to you on the way.

There are other things you can do that may or may not reduce the chance of getting AMS. One is to eat well: fatigue is said to be a major contributor to AMS, so try to keep energy levels up by eating as much as you can.

Dehydration can exacerbate AMS too, so it is vital that you drink every few minutes when walking; for this reason, one of the new platypus-style water bags which allow you to drink hands-free without breaking stride are invaluable. Wearing warm clothes is very important too, allowing you to conserve energy that would otherwise be spent on maintaining a reasonable body temperature.

Although there hasn’t been a serious study on this subject, many people swear that carrying your own rucksack increases your chance of succumbing to AMS. Certainly, in my experience, this is true, so, finally, hire a porter to carry your baggage.

Diamox

Acetazolamide (traded under the brand name Diamox) is the wonder drug that fights AMS, and the first treatment doctors give to somebody suffering from mountain sickness. Indeed, many trekkers use it as a prophylactic, taking it during the walk to prevent AMS.

Diamox works by acidifying the blood, which stimulates breathing, allowing a greater amount of oxygen to enter into the bloodstream. Always consult with your doctor before taking Diamox to discuss the risks and benefits. If you do take it, remember to try it out first back at home to check for allergic reaction, as Diamox is a sulfa derivative, and some people do suffer from side effects, particularly a strange tingling sensation in their hands and feet.
The disadvantage with taking AMS prophylactically, according to one doctor serving on the Annapurna Circuit in Nepal, is that you are using up one possible cure.

That is to say, should you begin to suffer from AMS despite taking Diamox, doctors are going to have to look for another form of treatment to ensure your survival. For this reason, a number of trekkers are now buying the drug and taking it up the mountain with them, but are using it only as a last resort when symptoms are persistent. If you are unfamiliar with Diamox and uncertain about the effect it could have on you, this is perhaps the best option.

Other effects of altitude

There are other symptoms than AMS suffered by people at high altitude that are not in themselves usually cause for any concern. The first is the phenomenon of periodic breathing. What happens is that, during sleep, the breathing of a person becomes less and less deep, until it appears that he or she has stopped breathing altogether for a few seconds — to the obvious consternation of those sharing the person’s tent.

The person will then breathe or snore deeply a couple of times to recover, causing relief all round. Another phenomenon is that of swollen hands and feet, more common amongst women than men. Once again, this is no cause for concern unless the swelling is particularly severe. Another one that is far more common among women than men, is irregular periods. The need to urinate and break wind frequently are also typical of high altitude living, and far from being something to be concerned about, are actually positive indications that your body is adapting well to the conditions.

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