PERU. (On) live in the city the highest city in the world

240 hours. For ten days, our team of scientific explorers is still in the highest city in the world, in Peru, at 5300 m altitude. It's hard to imagine what that means until you've lived it. It is there, with marked faces and strong rings, that we continue to help and study the population accustomed to these extreme conditions. At the limits of the human body, where the permanent habitat is considered impossible, in theory.

If my body is still struggling to adapt to the lack of oxygen, I begin to take my bearings in this city of 50,000 inhabitants. I will even say that I am attached to it and that my eyes have changed. Less in surprise and more in sharing. As often, what makes the beauty of an expedition, a journey or an epic, is the meeting. The one that comes to offer a story to the decor.

Credits: Axel PITTET and Tom BOUYER – Expedition 5300.

A miner with swollen, purplified hands and lips

Behind science are hiding humans. Lives. And contrasts. Where for us Westerners, accustomed to comfort, this daily seems unthinkable, La Rinconada continues to grow. Like a city out of time. With its mysteries and its problems.

In the vicinity of the ephemeral laboratory, I meet a miner, Juan Carlos, with swollen hands and lips, violaceous. He is lining up to meet our team of scientists. I ask him how he is doing. I try to understand somehow, with my wobbly Spanish, what he describes. He shows me his head first then his heart … We end up discussing everything and nothing, like two old friends over a drink. Juan Carlos explains to me that he works at the mine to pay for the law studies of his daughter, in Lima. And it's easier to find work here than in the big cities around.

© Axel PITTET – Expedition 5300

As the snow tips his nose, Juan Carlos and I arrive at the entrance of the laboratory. Objective: collection of first information. To put it simply, the ephemeral laboratory is cut in half, with a yellow tarpaulin as separation. A bit spartan but it does the trick. This is where our paths separate and through a last handshake and a look, I hope unconsciously to transmit all my energy and my courage for the future.

Expectations and meetings: unbelievable on all levels!

The patience of the miners is incredible. Every morning, upon our arrival, the Peruvians queue to be evaluated. To understand what they have. With their own story. Some have never seen doctors or needles. A world separates us and yet, we live well on the same planet.

Concentrated, writing on paper probably first results, I meet the eye of Ivan Hancco, Peruvian doctor. I allow myself to steal a little time to know the criteria that are taken into account in the context of Expedition 5300: men, aged between 18 and 55 years with a BMI (body mass index) less than 27 who were born at an altitude above 3500 m and who have lived in La Rinconada for at least 3 years.

© Axel PITTET – Expedition 5300

After initial assessments, two groups are created: twenty-five Peruvians with a chronic mountain sickness score greater than 10 and twenty-five peruvians with no chronic mountain sickness, that is, with little or no specific symptoms associated with altitude.

Hypoxia: different facets?

What is happening among the inhabitants of La Rinconanda? I see them sitting in what looks like a waiting room. Singular faces, swollen cheekbones, bulging eyes but an expression that does not change when you take the time to talk to them: a smile masking the harshness of their daily lives. Some are proud to be here, others probably do not have a choice and do not know other horizons of life. At each meeting of a new patient, I discover a Samuel Vergès, the person in charge of Expedition 5300, more human than scientist. A look that does not deviate during exchanges, almost sorry not to be able to respond to everyone's requests.

© Axel PITTET – Expedition 5300

Fifty. It is the number of Peruvians who will be able to pass on the other side of this yellow tarpaulin. The others, nearly a thousand will still receive a health check from medical students in Puno, under the leadership of Dr. Ivan Hancco. It is this comparison of scientific data, between two groups, which must make it possible to understand what are the differences involved in chronic mountain sickness. In a second step, the analysis of the data should lead to determine the therapeutic solutions to help the Peruvians to live better in these conditions.

© Axel PITTET – Expedition 5300

And for us, inhabitants of the plain, how is acclimation going?

As every morning, we find ourselves in the laboratory after a walk of ten minutes we climb some stairs, always trying … We cross a small market where already at 7:30, the smells of fries are felt as if life did not stop here. And as every morning, the faces, each time, become a little deeper, the eyes a little more closed even if the team is one.

One of the members, around what looks like a coffee launches, “Today, one more notch at the belt level”. We laugh and we say that altitude is a good solution to lose weight. Emeric Stauffer, doctor, explains that altitude is known to reduce the feeling of hunger (reduction of a hormone that stimulates hunger, Ghrelin), phenomenon known as “altitude anorexia”. In digging a little bit, I even read that a study in the United States found that when the altitude of residence increases, the rate of obesity drops. However, here, the inhabitants are rather corpulent. A genetic heritage to protect oneself from the cold? inappropriate eating habits? Good questions …

© Axel PITTET – Expedition 5300

On a quieter afternoon, Samuel and I decide to go for a walk in the mountains and discover the secrets that are hidden above the Rinconada while the rest of the team is resting. We need it. We discover another world. More wild. Probably more authentic. Although after every step, I feel the lack of oxygen gnaw my muscles, my heart beat faster, the desire to explore takes over and allows us to decompress. It must be said that hypoxia – by all that it induces – must necessarily affect morale. Even after ten days, our body did not adapt completely. The nights for some remain chaotic. The spirit a little elsewhere.

Hypoxia: behind myths, reality.

When I talk with people of the plain, all, without exception or almost, tell me “to hang on”, that I will come back with “a box of hell”. I think it's more complicated. I like to remind myself that “it's the dose that makes the poison” as Paracelsus wrote, one of the pioneers of medicine from the sixteenth century. Complex.

Will the increase of red blood cells that I produce today by the lack of oxygen will allow me to be less tired, run faster? Not sure. Conditions-related days are difficult and prolonged exposure to hypoxia can be deleterious. A small drop in our energy production capacity due to a lack of oxygen can be responsible for fatigue, impaired immune defenses and cognitive difficulties.

© Axel PITTET – Expedition 5300

Everything seems to matter of dosage. For example, Samuel explains that living and aging at moderate altitude (1500 m) could delay or offset several pathologies and reduce some mortality factors. Several studies have shown that with altitude training, one can obtain superior benefits (cardio-respiratory, physical condition, body composition) to a normoxia (plain) exercise training program.

And the reality of everyday life …

Be that as it may, here the altitude is queen. The people of La Rinconada are aware that something is wrong. But they relativize and continue to celebrate life. Despite the difficulties of everyday life. Where Anne Sauvy wrote in Mountain rescue (1998) that “the mountain was a mixture of concrete and real horizons in the distance of mist and light – but also horizons of balance, wonder, joy, inner plenitude.” It is, for them, a test that must be faced every day and which imposes the understanding and respect of all of us.

Axel PITTET, mountaineer and shipping communication manager 5300

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