Eighty-six and counting. With two weeks still left for the Amarnath Yatra to draw to a close,the pilgrim death count on the mountain trail looks set to cross last years toll of 105.
Inquiries by The Indian Express reveal that most deaths this season have been due to health reasons,that pilgrims have been concealing their medical history of cardiac and respiratory problems to undertake this difficult journey,that many are egged on by travel agents who wave package deals and do not insist on health certificates made mandatory this year by the shrine board. Others simply travel with certificates obtained without health checks.
Men,women and children have been trekking without medical certificates,many in slippers with little or no protective gear. Medical camps on the trek route lack basic facilities and most pilgrims have no idea of the health problems they can encounter during the climb.
The trek to the Amarnath cave shrine is a difficult one. The first route is the longer one: Pahalgam-Chandanwari-Pissu Top-Sheshnag-Panchtarni-Cave. The other route is via Baltal-Domail-Barari. On the Baltal route,the distance till Panchtarni can be covered via helicopter.
Many like Mohan Singh (41),who works at a brick kiln in Jharkhand,stick to the longer route,one that snakes its way up from Pahalgam. This season,Singh completed the yatra with his wife and three children without medical certificates,wearing only plastic slippers and light woollens.
While Singh and his wife were registered with the shrine board,they did not seek medical clearance for the children. It was the first mountain journey for my children,they had minor breathing problems. We stopped at a medical camp in Sheshnag. But nobody tried to stop us,nobody asked us for medical certificates, he said.
Lal Chand from Rishikesh,accompanied by his 7-year-old son,finished the journey in two days. They too did not have medical certificates. Nor were they stopped.
But there are also many who,despite having medical certificates,are unable to complete the journey. Ashok Kumar Gupta (58),a photocopy machine operator from New Delhi,was not planning to go on the yatra this year. A registered yatri,he decided to accompany his wife and teenaged daughter after his son dropped out.
On July 11,after a pony ride from the Pahalgam base camp,Gupta collapsed at Sheshnag. Doctors at the Medical Aid Centre at Sheshnag said Gupta died of cardio-respiratory arrest.
Wife Kamala Devi,who is now back in their Trilokpuri home in Delhi,says she held him in her arms for at least 15-20 minutes as he struggled to breathe.
My daughter and her friend were on foot,they turned up much later. At Pahalgam,my husband said he had a headache. But he felt better after he ate,so we decided to go ahead the same day, Kamala said. At Sheshnag,he had difficulty breathing. I called out to the other pilgrims,one of them managed to get a jawan who rushed him to the medical camp.
Guptas daughter Parvati said: We tried to ask the doctors but they had taken my father inside. I felt weak,so I asked for glucose,but there was none. Around 10 pm,she got a phone call from her brother in Delhi. He said he received a call from the hospital about fathers death. And all this while,we had been waiting there.
The family believes Gupta might have lived if medical help was available along the route,between camps. In the newspapers they say there will be medical help and oxygen cylinders all through the route. I did not see any, Kamala said.
Travel agents in Delhi say that no registration is required for helicopter yatris on the Baltal route. Of seven travel agents that The Indian Express contacted,four said packages of Rs 14,000-20,000 for two nights and three days cover the registration though a medical certificate will be needed. Three said that on the chopper route,no medical certificate will be sought.
Many yatris who had certificates said they had not undergone medical checks. Subhash Chander Sarkar of Kolkata,admitted to a Pahalgam hospital for a heart problem after collapsing near Sheshnag,said: My family doctor did not perform any test,it was just a routine examination.
Ashish Gupta,son of Ashok Gupta who died at Sheshnag,said a colony doctor gave them certificates without conducting tests.
Delhi-based cardiologist Dr K K Aggarwal,writing in eMedinews,said medical certificates from non-specialists without specifications of tests do not suffice.
The minimum test that they can do is a six-minute walk test. It is a basic internationally-accepted test to measure exercise tolerance in patients of cardiac and pulmonary diseases before issuing certificates, Dr Aggarwal told The Indian Express. As per standards,a healthy adult should be able to cover 400-700m in six minutes without feeling breathless.
Dr Y K Mishra,who heads the cardiac surgery department at Escorts Hospital,had been on the yatra with his wife and daughter in the second week of July via the Baltal route.
We took a helicopter to Panchtarni. Then its a trek of about 6 km to Amarnath. There are health camps,managed by the state and CRPF,at both ends of the climb at Panchtarni and Amarnath,but no facilities en route, Dr Mishra said.
He said his 13-year-old daughter began feeling breathless en route but they had to wait till the end of the trek to take her to a medical camp. We asked for glucose but they did not have any at the state health camp right near the shrine where people were collapsing at the end of the yatra, he said.
A minimum treadmill test is required to assess cardiac fitness for the trek. An ECG alone will not suffice. You need to know how the pilgrim reacts during exercise, Dr Mishra said.
When his comments were sought,J&K Health Director Dr Saleem-ur-Rehman said: It is not practical to provide camps every two kilometres. There are 26 camps spread out evenly,including the Baltal and Pahalgam routes,and these are adequately equipped.
He said that on the 6-km route after Panchtarni,there is no equipment to assess cardiac function of yatris since the climb is like moving on a plateau,not steep or long enough.
In April this year,the Sher-I-Kashmir Institute of Medical Sciences published a study on diabetics who reported with life threatening metabolic disorders from the Baltal base camp in the last two years. Twenty per cent of these patients were not aware that they had diabetes.
There is immense need for a special health education programme and special services for diabetics during yatra. Yatris should undergo pre-pilgrimage health clearance,carry medical records,learn about symptoms and signs of hypoglycemia,importance of hydration,need of caloric intake,compliance with medications or insulin,and importance of periodic glucose monitoring,in addition to wearing protective shoes and identifying wrist bands. Specialised services for diabetics would alleviate a lot of stress during the yatra, the authors noted.
Doctors posted at the health camps say that though they advise pilgrims who report sick not to continue the journey,few take them seriously. Dr Fayaz,posted at the Pahalgam camp,said: We can only give advice. The rest is up to the shrine board officials.
Navin Choudhary,Chief Executive Officer of the Amarnath Shrine Board,declined comment.