Peter Labib and Jeremy Jordan: Conducting research in developing countries can be as challenging as climbing Everest

Jeremy Jordan and Peter LabibThe elective is the highlight of a medical student’s time at medical school. As keen trekkers, we decided to conduct a project in Nepal on the effects of altitude on the hormone hepcidin. The project involved following trekkers ascending to Mount Everest base camp, collecting urine samples, freezing them, and then transporting them back to the UK for analysis.

Unsurprisingly, there is no reliable electricity supply at any point on the trek route or indeed in Nepal; the nation’s grid is supplied by a single hydroelectric dam, with only intermittent supply. This left us with two options for freezing the samples; liquid nitrogen or a portable freezer. We contacted a UK company that loans medical equipment and were assured that we would be provided with a freezer that they would send directly to Kathmandu. However, a week later in Nepal, the company sent us an invoice for £2400 to borrow the freezer – who would pay £2400 to borrow a freezer if they could buy one outright for £1800? After declining this offer, we decided to ask our supervisor for help.

We e-mailed our Nepali supervisor, but unfortunately he was on the Everest trek himself with the England cricket team whilst they were attempting to break the world record for the highest game of cricket ever played. Eventually, when we met him, he told us that liquid nitrogen was used in all major expeditions that had gone before us and he gave us the contact details for a gas company. When we telephoned the company, they confirmed that they could get us liquid nitrogen, but no container. After a few telephone calls, we found a company which was willing to lend us a 20-litre liquid nitrogen container at a reasonable price. However, we had to work out how to get the container to the start of the trek in Lukla. Normally, people start the trek by flying there, as the alternative is an 8 day trek. Not surprisingly, no commercial plane or helicopter would touch liquid nitrogen due to the risk of explosion with the pressure changes during the flight, so we paid a porter to carry the container the whole way. We booked our flights to coincide with his arrival and had our first stress free evening!

The project went on without a problem until 2 days before the end when we found that someone had tampered with the container overnight and broken the insulating bung that maintained the integrity of the container. Our guess is that a curious local had decided to ignore the giant Nepali warning on the box saying “Liquid nitrogen, do not touch.” In true Blue Peter style, we managed to make a bung from old polystyrene and duct tape. This seemed to do the trick, and we were pleasantly surprised when the container arrived back in Kathmandu with our frozen samples. After a two month delay, our samples were finally delivered to our UK laboratory. On opening the container, we were shocked to find that all the markings on the tubes had rubbed off – we had no way of telling the samples apart and we had no data for any publication. The elective had cost us nearly £ 5000 but all we had to show for was 130 urine samples from another continent!

Despite this disheartening result, we are planning to re-attempt this unfinished business; next time we will have the most permanent marker pen that money can buy.

Peter Labib is an FY1 doctor working in London. He enjoys climbing and cycling and is interested in a career in relief medicine.

Jeremy Jordan is an FY1 doctor working in Worcester. He enjoys climbing and camping and is interested in a career in anaesthetics.