The Amazing Race 6, Episode 8

l'Ile Rousse, Corsica (France) - Nice (France) - Addis Ababa (Ethiopia) - Lalibela (Ethiopia)

The invisible hand influencing "The Amazing Race" this week in Ethiopia may have been the altitude: over 2500 meters (8000 feet) above sea level in both Addis Ababa and Lalibela.

Kendra had what she thought was an asthma attack, to which the altitude could have contributed, or which could have been simply symptoms of altitude, mistaken for asthma. Other racers were shown panting for breath, or having difficulty maintaining their expected walking pace on the hilly trails around Lalibela. And some of them looked and acted as though they might have been feeling a bit light-headed, dizzy, or slightly confused. All of these might have been consequences of the altitude, especially given their rapid ascent followed immediately by aerobic exercise without time for rest or acclimation.

The racers were required to do pretty much everything possible to maximize their chances of ill effects from the altitude. As a result, real travellers can learn a lot from this episode about what not to do if you don't want unnecessary discomfort.

I'm not a doctor. For more detailed and professional advice, I recommend that you consult your doctor (as you should at least a month before any big trip) and Staying Healthy in Asia, Africa, and Latin America (Avalon Travel Publishing, 5th edition, 2000), by public health expert Dirk Schroeder. This is the book to read before your trip for preventive advice, and the medical guide I always carry with me when I travel outside the First World. (This was also the book that first attracted me to the company now known as Avalon Travel Publishing, which later became my publisher as well.)

But here's my best understanding of what you can do if you don't want to have the same problems the racers may have had:

1. Be aware of the altitude. At least in daylight, a significant altitude gain is usually obvious when you are travelling by road or rail. When I rode from Kashgar at 1,300 meters (4,000 feet) to Tashkurgan at 4,000 meters (13,000 feet) in one day on the Karakoram Highway, I had no doubt our jeep was climbing, and I wasn't surprised that I didn't sleep soundly that night, or that I got out of breath in a few steps when I got out of the jeep at 5,000 meters (16,000 feet) at the Khunjerab Pass. But altitude gain between takeoff and landing of a long-haul flight, such as from sea level in Europe or Cairo to Addis Ababa, is generally imperceptible, even on a clear day. Altitude gain might have been noticeable on a clear day from a small plane flying close to the ground, but Addis Ababa and Lalibela are at similar altitudes on the Ethiopian Plateau. And whether from the air or the ground, there's no necessary visual distinction between high plains and flat lowlands. I suspect that none of the contestants in the race realized that they were at an altitude high enough to affect their performance, or would have realized without looking it up or being told. Only if you are aware of the altitude can you adjust your actions to compensate for it or minimize its effects.
   
   
2. Altitude doesn't have to be extreme to have perceptible effects. "Altitude sickness" isn't just a phenomenon of the highest mountains, or of icy cold heights. Most people begin to "feel the altitude", especially during physical exertion, at between 1,800-2,500 meters (6,000-8,000 feet) above sea level. Anywhere above that height, shortness of breath, dizziness, light-headedness, headaches, or difficulty sleeping might be symptoms of the altitude. And near the equator -- in the Andes, on the African highlands, or on mountains in Southeast Asia, for example -- the climate even at altitudes considerably higher than that can be quite mild and warm.
   
   
3. Go slow. Ascend gradually. Give your body time to adjust to higher altitude and thinner air. The rule of thumb I've heard for high-altitude climbers and hikers is to try not to sleep more than 300 meters (1000 feet) higher each night than the previous night, even if you go higher during the day. If logistics require you ascend more rapidly, especially if you have to fly directly to a significantly higher altitude, don't plan to do anything but rest and acclimate for at least a day, and don't plan any hard physical labor or strenuous activity for several days, depending on the amount of altitude gain. The day after flying from sea level to 3,000 meters (10,000 feet), a half-day walking tour that includes a few flights of steps could leave you feeling like you've run a marathon. Don't think you won't feel the altitude because you're young, healthy, physically fit, or haven't had problems at high altitudes in the past: some people are, for no apparent reason, much more susceptible than others to the effects of altitude. Susceptibility to altitude can vary unpredictably through an individual's life, so you might suddenly become uncomfortable at an altitude you've been to many times before without ill effect.
   
   
4. Be aware of your body. If you have trouble breathing or feel weak, dizzy, or lightheaded, slow down. Learn from the racers' careless-seeming mistakes, such as those that led to Victoria and Jonathan's elimination: Keep reminding yourself that your oxygen-deprived brain may not be thinking entirely clearly, and double-check any critical or complex tasks you have to do. Most healthy travellers, even coming from sea level to the world's highest major cities, experience only a few days of minor discomfort from altitude. But if you do experience serious or continuing symptoms of altitude sickness, descend immediately. Often there is a critical "threshold" altitude, and descending a few hundred meters (a thousand feet) can bring dramatic and nearly instantaneous relief. If a quick descent isn't possible, or isn't sufficient to relieve your symptoms, seek immediate medical help.