Health Essentials for Traveling in Nepal

Trekking is a wonderful experience and most people look forward to a trek in Nepal as the adventure of a lifetime, when traveling sickness is sometimes a problem. Trekking in Nepal need not be considered risky affair as far as your health is concerned. But very little medical care along the trail is available, so make sure you are physically fit and healthy before departing.

Here are some guidelines on staying healthy:

Trips are one of the best ways to take a break from the monotonous routine of your day to day lives. As soon vacations arrive, we all hurry up to run to one or the other travel destination where we can relax, enjoy and spend our holidays. Staying in that place, exploring, enjoying, indulging you in the delicacies out there, it all sounds so magical! But remember, all this can get spoilt by nothing but your own health, if you don't be cautious about wellbeing needs!

You can enjoy your vacations only when you feel healthy and spirited from inside. And, if your health does not support you these enjoyable vacations to a great destination, become a burden and nothing else! So, here we present you with tips on staying healthy, before you go on a trip and while you are away.

Before you Go

1. Immunizations or vaccinations if needed should be taken least 6 weeks before you leave. Some vaccines need about 6 weeks after you get the shots to reach to the highest protection level
2. Medical and dental check-ups are important before your trip, to be aware of problems if any. Then accordingly you can find out about medicines you might need to take along.
3. Enquire fully about your health insurance, in case you might see a doctor while you're in another country. Carry enough of your regular medicines in their original containers, along with extra prescriptions for them. Also bring your eyewear prescriptions. Do bring a first-aid kit along.

Vaccines you Might Get

Nepal doesn’t officially require any immunizations to enter the country. However there is several major disease that can be prevented, or the risks significantly decreased, by immunisations.

Consult your doctor once before your trip, so that he can decide if you need any vaccinations, but the vaccinations you should consider for a Nepal trip include the following.

1. Hepatitis A
2. Hepatitis B
3. Japanese Encephalitis
4. Meningococcal meningitis
5. Polio
6. Rabies
7. Tetanus and diphtheria Toxoids
8. Typhoid fever

Malaria:

In Nepal there is no risk of malaria in Kathmandu, Pokhara and all the trekking regions, the risks on the Terai is also very low, there is no risk of malaria for visitors to visit Chitwan National park for Jungle safari adventure

Carry along First Aid Kit

The first aid kit that you carry along should contain the following :

1. Your Prescription medicines in their original containers.
2. You must carry medicines for diarrhea and stomach problems. Get a prescription from your doctor of medicines that you must take if caught by traveler's diarrhea.
3. Cough and cold medicines are essential.
4. Pain killer medicines such as aspirin etc. are also a must to carry.
5. For allergies, Decongestants and antihistamines are recommendable. While travelling, prefer the one's which don't cause sleepiness.
6. Adhesive bandages, Antibiotic ointment, moleskin for blisters, sunscreen with SPF at least 15 and a lip balm.
7. Medicines for motion and altitude sickness are recommended.
8. Scissors, nail clippers, tweezers, pocket knife, thermometer and a mirror.
9. Hand sanitizers and wipes.

Treatment summary for the main gastrointestinal illness

Bacterial diarrhea: ciprofloxacin (500mg every 12 hours for one day)

Giardiasis: tinidazole 500 mg ( four pills all ot ones days day fro two days

Amoebiasis: tiidazole 500 mg ( f our pills all at once each day for three days, follow by paromomycin 500mg three times a day for 10 days

Cyclospora:trimethoprim-sulfamethoxa-zole ( eg Bactrim, one pill every day 12 hours for seven days)

Note (on our every trekking and tour holidays our tour and trek leaders take a first aid kid with all necessary medicines and they got special training for first aid)

On Your Travel and Trekking in Nepal :

Understanding Diarrhea in Travelers

Diarrhea - general information

 

Nepal is one of the countries with highest risk for gastrointestinal illness in the world. Approximately one third of patients who are seen at CIWEC Clinic do so, for diarrhea. CIWEC Clinic has performed extensive research on diarrheal diseases in travellers and expatriates and what is said below is borne out by the research that has been performed at this clinic.

What causes diarrhea?

Bacterial infections - Most cases (approximately 80%) of diarrhea are due to bacterial infections. It is characterized by the abrupt onset of uncomfortable diarrhea and cramps. Diarrhea often begins in the middle of the night or early morning. Nausea, vomiting and fever can occur, but are not necessary to make the diagnosis. Bacterial diarrhea can resolve spontaneously without medication but the illness has the potential to last for up to 2 weeks and cause problems like dehydration, fatigue and loss of time from work. Replacement of lost fluids is very important in preventing dehydration. The length of this illness can be dramatically shortened by antibiotic therapy.

Giardia - A parasite that causes a relatively low-grade, chronic diarrhea associated with stomach rumbling, gas, abdominal cramping and 3-5 loose stools per day. It can sometimes cause a lot of watery diarrhea. Fever almost never occurs with giardia. Sulfurous smelling burps and farts, sometimes seen in Giardia infections, are equally common in bacterial infections and therefore not a reliable finding. Giardia is responsible for causing 11% of diarrhea diagnosis in travellers and expatriates.

Amebic Diarrhea - This is a very rare cause of diarrhea (approx 1% only). Usual presentation seems to be chronic diarrhea alternating with constipation. Fatigue and weight loss are common complaints as the illness persists. Can progress (rarely) to mucousy and bloody stools, which is then referred to as "amebic dysentery."

Cyclospora - A protozoan parasite that causes infections from May to August each year, with most of the cases occurring in June and July. Most of the time, the disease starts with an abrupt onset of diarrhea and may be accompanied by low grade fever, nausea or vomiting. The disease then has a waxing and waning course with profound fatigue, loss of appetite, and diarrhea that comes and goes. Untreated, the illness can last for several weeks.

Worms- An intestinal parasites that almost never causes diarrhea but may sometimes, cause mild abdominal pain. Hookworm can cause anemia. Worms are seen more commonly in children. Occasionally, an adult round worm which looks like an earthworm gets passed with stool and is a source of great anxiety to parents.

Symptomatic Treatment of Diarrhea

When diarrhea or vomiting occurs, it is important to replace fluid and electrolytes to prevent dehydration. This can be done fairly easily with an electrolyte solution mixed in a liter of boiled and filtered water or one liter of mineral water. Some commercially available products are Nava Jeevan and Jeevan Jal. Other fluids that can supplement the oral rehydration solution are: coca-cola/sprite without the bubbles, herbal teas, weak teas, clear soup, Tang solution, Gatorade. Alcohol and heavily caffeinated products should be avoided. It is important to urge young children with diarrhea to drink liquids frequently since they can become dehydrated quickly from seemingly small fluid losses. Adults should drink 3 liters or more fluids per day depending on the amount lost as diarrhea or vomiting.

Bowel paralyzers, such as loperamide, can give temporary relief of abdominal cramps and diarrhea, but do not shorten the illness or treat the cause. The use of bowel paralyzers is justified, however, when facing a long bus or plane trip, or when you are trying to continue to trek.

Treatment with loperamide: Take 2 pills to start, then 1 pill after each loose stool (not to exceed 8 pills a day) until the diarrhea stops. Do not use loperamide if you have bloody diarrhea unless you take an antibiotic with it.

Water Purification and Food Precautions

All water in Nepal must be assumed to be contaminated. Water can be purified by bringing it to a boil. An alternative to boiling water is to add liquid iodine (Lugol`s solution) at the rate of 4-6 drops per liter. The water is safe to drink after 20-30 minutes. Cold water takes longer to purify than warmer water. Iodine is also available in tablet form. The iodine taste and odor can be completely removed by adding a small amount (50 mg or so) of vitamin C after the water is purified. Hotel and restaurant water that is said to be boiled and filtered may not always be. Bottled water in Nepal is reasonably safe to drink.

Some restaurants soak their salad vegetables in iodine or other disinfectants which render them safe to eat. Otherwise, avoid any raw vegetable or fruit that cannot be peeled. Foods that are cooked once during the day, and then vaguely reheated before serving, such as quiche and lasagne are high risk foods because bacteria can multiply in them during the day. Blended fruit and yoghurt drinks ("Lassis") were found to be highly associated with diarrhea and should be avoided.

Remember, you cannot completely control what you eat, and no matter how careful you are, you can still get ill. Take reasonable precautions, as suggested, then relax and enjoy your food.

Availability of Health Care in Nepal

Kathmandu has several excellent clinics including the CIWEC Clinic have an excellent reputation in traveler and mountain health issue

CIWEC Clinic

Travel Medicine Center

Lazimpat, near British Embassy

PO Box 12895 , Kathmandu , Nepal

(Most of the above information is based on them)

On the trekking you may pass on hospitals at the trailheads or health post in larger villages, the Himalayan Rescue Association operate aid post in Pheriche (Everest Trekking) and Manang ( Annapurna Circuit trekking)