Altitude medicine often centres around visitors — climbers, trekkers, and lowland travellers — but far less attention is given to the chronic health challenges faced by people who live permanently at high elevations. This presentation focuses on altitude-related ailments in rural mountain communities, particularly chronic mountain sickness (CMS), high-altitude cor pulmonale, polycythemia, and vitamin D deficiency.

Drawing on over 1,000 haemoglobin studies from both highlander (Sherpa) populations and lowlanders who have migrated to high altitude, this session highlights how altitude adaptation varies between groups and how these differences manifest in disease burden. The presentation is informed by nearly a decade of clinical practice in remote Himalayan clinics where formal infrastructure is limited, requiring practical, locally adapted approaches to care.

Through a blend of clinical observation and data, the talk aims to bring attention to the hidden burden of chronic illness in high-altitude residents. Participants will gain insights into the recognition and management of CMS and related conditions in resource-limited environments, as well as the broader implications for rural and remote medicine. The goal is to expand the dialogue on altitude health beyond acute illness and adventure medicine, toward a more comprehensive understanding of long-term impacts on mountain communities.