Staying Healthy in Nepal

The information given below is based on other sources or from personal experience and should not be treated as an authoritative guide. Please make sure you consult a qualified medical physician before you travel.

Inoculations

The following vaccines are required/recommended for Nepal:

You need to enquire at your local GP at least 6 months before departure.

Anti-malarial prophylaxis are only required if visiting the Terai or middle hills below 2000m. They are not required for Kathmandu or for trekking. Chloroquine and Paludrine are the typical drugs of choice.

Diarrhoea

Diarrhoea is a very common affliction in Nepal and can lay you out for 24-48 hours, making activities like trekking almost impossible. If persistent and left untreated, it can ruin your whole holiday. The major types of diarrhoea in Nepal and their treatments are as follows:

Drugs such as imodium or lomotil can be taken to provide symptomatic relief which can be useful if travelling but they do not treat the infection.

Oral rehydration solutions (e.g. Dioralite) should be taken when suffering from diarrhoea. These must be made with safe water to prevent re-infection. Sachets of rehydration salts can be bought in Kathmandu. Jeevan Jal is a well known brand.

Diarrhoea is a preventable illness. Tips for avoiding diarrhoea are as follows:

Treat all natural drinking water with iodine*
Drink only bottled water in Kathmandu
Make sure bottles are sealed when purchased
Don't buy bottled water from hawkers at bus stops or airports
Drink hot drinks or heated water if you are sure it has been heated above 75ºC
Avoid drinks that could have been diluted with cold water e.g. fruit juices, lassi, chang etc.
Avoid ionised water in Kathmandu restaurants
Avoid ice in drinks
Avoid salad unless you are sure it has been washed in iodine solution
Never brush your teeth in untreated water
Ensure plates and utensils are properly dried before use
Avoid under cooked meat
Avoid uncooked foods made with water e.g. fresh achars (chutney)
Wash hands in soap and dry properly after visiting toilet

*All running water in Nepal should be considered unsafe and must be treated, even when taken from mountain streams. Iodine is a much more effective water treatment against bacteria and protozoa (Giardia & Amoeba) than Chlorine-based compounds. It is, however, harmful if taken on a long-term basis. Iodine solution is available in Kathmandu but in poorly sealed bottles which can leak and concentrations are not always specified making it difficult to use safely. Instead, bring a dropper bottle or iodine tablets from home.

The unpleasant taste of iodine can be neutralised by adding vitamin C powder prior to drinking. About 50mg of ascorbic acid is enough for 1 litre.

For more info on diarrhoea, visit http://www.ciwec-clinic.com/diar/index.html.

Altitude Sickness

Altitude sickness or Acute Mountain Sickness (AMS) occurs when your body cannot properly adapt to the lower amounts of oxygen found in the air at high and extreme altitudes. Acclimatisation is the process by which the body adapts.

Symptoms of mild AMS include headaches, sleeplessness, vivid dreams, breathlessness & hyperventilation, nausea, loss of appetite, lethargy, increased urination and dehydration if not drinking enough.

Altitude sickness can develop into High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE), which can be fatal if not treated quickly. Primary treatment is rapid descent to a lower altitude.

Most people suffer from some form of mild altitude sickness and most people will acclimatise to high altitudes, but not everyone. The principle ways to avoid AMS or to prevent mild AMS from worsening are as follows:

Ascend slowly, max 300-400m per day, and take rest days
Build strategic “rest” days into your trek
Drink plenty of (treated) water
Take Diamox (acetazolamide) for mild AMS treatment (dosage = half of one 250mg tablet every 12 hours)
Be honest about symptoms and don't mask with painkillers
Split into smaller groups & travel at different rates if required
Descend to lower altitude if symptoms persist

For more information on AMS, visit http://www.high-altitude-medicine.com/AMS.html.

Other Medical Problems

Dehydration and cramp can be a problem at high altitude, especially if taking Diamox which is a diuretic. Symptoms of dehydration are similar to AMS - headache and lethargy - but you can tell that you are dehydrated when your urine is too dark. Drink plenty of fluids containing salt and sugars such as soup and tea, and avoid excessive alcohol. Oral rehydration solutions are a good treatment.

Cough and cold symptoms are common at altitude because the excessive breathing of cold dry air damages the bronchi. Carry remedies if such things bother you. Vitamin C or multivitamins can help to maintain general good health. In rare cases, serious chest infections such as bronchitis and pneumonia can develop. If suspected, you will need immediate medical attention.

Blisters and foot infections can ruin a trekking holiday if allowed to develop. If your boots are rubbing, stop and remove them and cover the affected area with a plaster or tape. Don't wait until the blister appears before treating it. At the end of a trek, wash your feet (even if you wash nothing else) and change into different socks and footwear. Take a pair of nail clippers and cut your toe nails regularly to prevent them from rubbing in your boots. If you suffer from athlete's foot, take cream for treating it.

Snow blindness can develop at high altitudes even where there is little snow cover because the UV light is more intense. To avoid, wear UV blocking sunglasses. If you lose your sunglasses, cut two narrow slits eye distance apart in a strip of cardboard and wear over the eyes. You will look silly but at least you will keep your eyesight.

For more information on trekking health, visit http://www.project-himalaya.com/info-health.html.