Himalayan Rescue Association aid posts at Manang and Pheriche

The Himalayan Rescue Association (HRA) is a Nepali non-profit that runs seasonal aid posts staffed by volunteer doctors on the two busiest high-altitude routes. The best-known posts are at Pheriche (about 4,371 m) on the Everest Base Camp trail and at Manang (about 3,540 m) on the Annapurna Circuit, and both are walk-in, seasonal and focused on altitude illness. If you are heading up either route, plan the day you reach them.

This guide covers what each post does, what the daily altitude talks cover, how to prepare and the limits of what a volunteer clinic can do. It is general information, not medical advice, and posts change hours and staffing between seasons, so confirm the current arrangements with the HRA before you rely on any of this.

What the HRA is and does

The association was founded in 1973 as a response to deaths from altitude illness among trekkers. Its work is part rescue, part education: running aid posts at key villages, teaching staff at lodges and guiding agencies, and publishing guidance on acute mountain sickness (AMS), HAPE and HACE. The posts are in the main trekking seasons, typically spring and autumn, with doctors rotating in from around the world.

Two things to understand about them:

• They are seasonal and volunteer-run. Do not assume a doctor will be present in winter, in the monsoon or on the shoulder days of a season.
• They are an information and first-response service, not a hospital. Serious cases are stabilised and then moved down, by foot, porter or helicopter.

Pheriche (about 4,371 m): Everest route

Pheriche sits in a wide valley between Pangboche and Dingboche, one of two options for the second acclimatisation day on the Everest trek. The aid post is a stone building where the doctors see trekkers for headaches, coughs, stomach problems and altitude symptoms and give an afternoon talk.

What to expect:

• A briefing on AMS and how to tell mild from serious symptoms, usually delivered in the late afternoon in the main season.
• A chance to have your oxygen saturation and pulse measured and discussed in context. These numbers vary a lot between people, so the doctor interprets them rather than giving a pass or fail.
• Advice on whether to continue up, rest or descend, and help arranging evacuation if needed.

Most trekkers walk past Pheriche on the way up via Dingboche, which means you only see the post if you plan to stop there. Many agencies deliberately use Pheriche as a rest-day location for this reason. If your itinerary has you sleeping at Dingboche, you can walk down to Pheriche in about an hour for the talk and return, but that adds fatigue; discuss it with your guide.

See the Everest Base Camp itinerary for where Pheriche falls, and the Everest region page for the other villages on the route.

Manang (about 3,540 m): Annapurna Circuit

Manang is the acclimatisation stop on the circuit, which makes the HRA post one of the best-placed on any Nepal route. Trekkers arrive over two or three days from the Marsyangdi valley and many are already feeling the height. The post offers advice and an altitude talk, and Manang itself has a rest-day culture, with bakeries, short hikes and lodges used to altitude questions.

In practice:

• Go to the afternoon talk the day you arrive or the next day, before your rest-day hike.
• If you are unwell, tell the doctors and your guide the facts you know: when the headache began, what you have eaten and drunk, how you slept.
• If your plan is to cross Thorong La after Manang, ask the doctors whether you are on schedule.

The acclimatisation schedule shows where the steps above 3,000 m fall. The Annapurna Circuit itinerary gives the day-by-day sequence, and the Annapurna region page shows how the Manang valley connects.

What the talks teach

The altitude talks are short, practical and the same in spirit at both posts:

1. The three conditions, AMS, HAPE and HACE, and the symptoms of each.
2. Prevention: slow ascent, fluids, no alcohol on arrival, and the 500 m a night rule.
3. The golden rule: never go higher with symptoms, and go down if they worsen.
4. Medicine: what acetazolamide (Diamox) can and cannot do, and why you should discuss it with a doctor before travelling.
5. Staff and group behaviour: tell someone if you feel unwell, and do not leave an ill trekker alone.

You will leave the room knowing more than most trekkers in your lodge. Pass it on to your partners.

How to use a post well

• Arrive in the talk window. Ask your guide or lodge owner for the timings the day before.
• Bring your trip facts. Medications, existing conditions, allergies, insurer details and passport copy. Have the emergency number of your insurer on paper.
• Do not wait until you are very ill. A mild headache is a good reason to go in; waiting until the second day of worsening symptoms is not.
• Respect the doctor's advice. If you are told to descend, descend. Do not decide that a view is worth more.
• Make a donation if you are able, since much of the work is funded that way.

Limits to understand

• A volunteer post cannot guarantee a doctor is on duty on any given day.
• It cannot replace insurance that covers high-altitude trekking and helicopter evacuation.
• It cannot fix a schedule that is too fast. If you are being told repeatedly that you are climbing too quickly, believe it and add days.
• It has no authority over your guide or agency; you and your partners decide what to do.

Other places for help

Other health posts operate at places such as Namche Bazaar and Gorak Shep on the Everest trail, and hospitals and clinics are available in the lower valleys, such as at Lukla and Pokhara. If you are on a route without an aid post, such as Manaslu or Upper Mustang, rely on your guide's training, a good first-aid kit and a schedule with slack. For the wider picture see altitude sickness basics, and for how rescue and evacuation work, the partners and safety hub.

A sample visit, step by step

To make the process less abstract, here is what a sensible visit to the Manang post looks like on a rest day in October.

1. Morning. After breakfast, check how you slept and how you feel. Note the answers: headache yes or no, appetite, nausea, how often you woke.
2. Mid-morning. Walk a short acclimatisation hike with your partner and guide, such as to Gangapurna Lake. Drink water on the way.
3. Early afternoon. Walk to the aid post, put your name down if there is a list and read any notice boards. In the busy weeks you may wait.
4. Talk. Sit through the altitude briefing and ask one specific question about your itinerary, for example whether the planned night at Yak Kharka is sensible for someone who slept badly the night before.
5. Evening. Tell your guide what the doctor said, and agree the plan for the next morning before dinner rather than at breakfast.

The same sequence works at Pheriche. It takes two hours of an otherwise easy day, which is a small price compared with a bad night on the pass.

Common questions at the post

Having answers ready saves time:

• "Is this normal?" A mild headache, light sleep and a faster pulse at rest are common above 3,500 m and are not by themselves a reason to turn back. Getting worse over several hours is.
• "Should I take Diamox now?" Ask, but do not expect a prescription at the door; the doctors will generally say that it is better to have discussed it before the trip.
• "Can I carry on tomorrow?" The answer depends on symptoms after rest. If you are not better, you rest again or descend.
• "Is my partner okay?" Describe what you have observed, such as confusion or stumbling. Observers often notice before the patient does.

Things the posts cannot see

An aid post only sees the people who walk in. The riskiest trekkers are the ones who feel worse and stay in their rooms. If your partner is quiet at dinner, hasn't eaten and goes to bed early, go and check on them, and check again in the middle of the night if they are unwell. This is the practical reason for agreeing a buddy system in the first week, which is covered in the partners and safety guide.