· Minimizing gastrointestinal problems - Since most of Nepal still gets along without modern sanitation, these are endemic. They range from self-limiting attacks of diarrhea where dehydration is the main risk, through intestinal parasites, amoebic dysentery and giardiasis which are chronic without proper medical treatment, to immediately life-threatening infections like cholera and typhoid. Habituation even to common intestinal flora generally takes about a year and many unpleasant bouts of stomach problems, so tourists contemplating shorter stays should take extensive precautions. Filter or treat your own water, use bottled water, checking to make sure lid is sealed (limit use of bottled water since there's no place to dispose of the used bottles) or stick with beverages made from water that has been thoroughly boiled and filtered. Tea or coffee from cafes catering to tourists are 'generally' safe.
· When trekking carry iodine or other chemical means of treating water and be sure to follow directions, i.e. don't drink the water before the specified time interval to ensure that resistant cysts are deactivated. In trailside teashops, although glasses may be washed in questionable water, tea is made by pouring boiling water through tea dust into your glass. The chances of disease-causing organisms surviving that are small but not zero.
· Brush teeth with prepared drinking water and avoid water entering the mouth when showering.
· Salads, especially in the wet season, should be treated as suspect.
· Wash hands regularly and especially before eating.
· Thoroughly wash fruit and vegetables for raw consumption using boiled and filtered water. Also consider peeling them.
· Look for freshly-cooked food and avoid anything that has been cooked and then left sitting around without refrigeration (which can expose you to a buildup of bacterial toxins), or without protection from flies (which can transfer disease organisms and parasite eggs to the food).
· Get vaccinated and consider prophylactic treatment. You may be exposed to typhoid, cholera, hepatitis malaria and possibly even rabies.
· Practice safe sex or do without. The incidence of STDs is rising and the government has not always been proactive about treatment and promoting awareness. Unless your Nepali is extremely fluent, your chances of finding out about a prospective partner's sexual history are slim.
· Altitude sickness Permanent snow lines are between 5,500 m and 5,800 m (18,000 ft and 19,000 ft), so base camps and passes in the Himalaya are usually higher than Mount Blanc or Mount Whitney. This puts even experienced mountain climbers at risk of altitude-related medical conditions that can be life-threatening. Risks can be minimized by choosing routes that don't go high, such as Pokhara-Jomosom, or routes and trekking companies where gamow bags or other treatment are available, and by sleeping not more than 300 m (1,000 ft) higher per day. According to the "climb high, sleep low" mantra, it is good to take daytime conditioning hikes that push acclimation, then to return to a more reasonable elevation at night.
Acute altitude sickness is the mildest and most common form. Patients usually have a (mild) headache and/or less appetite, and nausea. These symptoms are quite common above 3,000 meters (10,000 ft). Nothing to be worried about (yet), but it is important to tell you guide or trekking companion about your symptoms, and keep close watch that they don’t get worse.
· Shortness of breath during exertion
· Decreased appetite
· Swelling of extremities
· Lack of sleep
· Social withdrawal
HAPE occurs when fluid builds up within the lungs, a condition that can make breathing extremely difficult. Onset of HAPE can be gradual or sudden. HAPE typically occurs after more than one day spent at high altitude. If left untreated, it can progress to respiratory collapse and ultimately to death.
· Shortness of breath at rest
· Extreme fatigue
· Gurgling respirations
· Dry cough or wet cough with frothy sputum
· Possible fever
· Respiratory failure
Another severe form of altitude sickness is high altitude cerebral edema (HACE), in which fluid builds up within the brain. As the brain swells with fluid, the person’s mental state changes. Loss of coordination, coma, and, finally, death can are the cause if not recognized and treated promptly.
· Difficulty with balance and coordination
· Hallucinations, lethargy, confusion
· As the brain continues to swell unconsciousness or coma will develop.
How to identify if someone is seriously suffering from AMS, HAPE or HACE:
· Ask the person to close his eyes and bring his finger to the tip of his nose.
· Ask the person to walk in a straight line
· Ask the person to put on pants (put his leg into one of the legs)
If he is not able to do so, the situation is serious!!
· In case of mild symptoms, stay at the same altitude. Ascend only when the symptoms have resolved completely
· In case your symptoms are getting worse while resting at the same altitude, descend
· In case of serious symptoms go down immediately! Helicopter rescue may be necessary.
· If the patient is not able to walk (due to serious symptoms) and can’t be carried down, an inflatable high pressure bag (Gamow Bag) can help. The bag restores the oxygen level and air pressure and is used as a treatment in acute situations. Some trekking groups carry a pressure bag, besides they are available in some lodges, especially in the Khumbu/Everest area.
· Never let a patient descend unattended
· If available, consult a doctor, also if symptoms are not yet very serious
· Hypothermia is a risk, especially if you are trekking in spring, autumn or winter to avoid heat at low elevations. When it is a comfortable 30°C (85°F) in the Terai, it is likely to be in the teens Fahrenheit or -10°C (14°F) at that base camp or high pass. Either be prepared to hike and sleep in these temperatures (and make sure your comrades, guides and porters are equally prepared), or choose a trek that doesn't go high. For example, at 3,000 m (10,000 ft) expect daytime temperatures in the 40s Fahrenheit or 5 to 10°C.
· Rabies - Dogs are not vaccinated and catch this fatal disease from other dogs or wild animals with some regularity. All mammals are potentially vulnerable. Dogs are considered ritually polluting and are widely abused, so it can be impossible to know whether a dog bit you because it is paranoid about people or because it is rabid. You should be vaccinated against rabies before going to Nepal, but this is not absolute protection. Be on the lookout for mammals acting disoriented or hostile and stay as far away as possible. Do not pet dogs, cats or pigs no matter how cute. Keep a distance from monkeys, especially in places like the Monkey Temple in Kathmandu. If bitten or exposed to saliva, seek medical attention. You may need an extended series of injections that provides a higher level of protection than routine vaccination.
· Snakebite - The risk is greatest in warm weather and at elevations below 1,500 m (5,000 ft). Poisonous snakes are fairly common and cause thousands of deaths annually. Local people may be able to differentiate poisonous and non-poisonous species. Cobras raise their bodies in the air and spread their hoods when annoyed; itinerant snake charmers are likely to have specimens for your edification. Vipers have triangular heads and may have thick bodies like venomous snakes in North America. Kraits may be the most dangerous due to innocuous appearance and extremely potent neurotoxin venom. Kraits are strangely passive in daylight but become active at night, especially around dwellings where they hunt rodents. Krait bites may be initially painless, causing only numbness. However without proper antivenin numbness can progress to deadly paralysis, even with bites from small, seemingly harmless specimens. Wearing proper shoes and trousers rather than sandals and shorts provides some protection. Watch where you put your feet and hands, and use a torch when walking outside at night. Sleeping on elevated beds and on second stories helps protect against nocturnal kraits.