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Altitude Sickless and Advise

Unlike Himalayan mountaineering, which has a morbid safety record, trekking in Nepal seems a safe and healthy pastime. That is, apart from the normal dangers inherent in high hills and travel in the Third World!

With precaution a few muscular aches and pains along with a mild bout of Kathmandu Quickstep should be all that most of us suffer. That said, the potential for sickness and injury is enormous: hepatitis, dysentery, cholera, malaria, meningitis and rabies are but a few of the nastiest that come to mind, along with altitude-related ailments such as acute mountain sickness (AMS), pulmonary and cerebral oedema, snow-blindness, hypothermia and frostbite, or, alternatively, sunstroke. Or quite simply you can be nudged off the trail and down the hill by a passing yak.

Fortunately, considering the crowds who now trek in Nepal, many of whom are not normally mountain hikers, the number of serious accidents is thankfully small. Normal health precautions are essential before any long-haul travel, and more so with trekking holidays where you will be in remote places for much of the time trekking relatively strenuous exercise daily. So here are a few tips.

Trekking is the most popular activity in Nepal, and travellers will be bombarded on the streets of Kathmandu and the trekking hub, Pokhara, with guides, organised tours and gear for sale or rent. The huge variety of options allows for people of many ages and capabilities to attempt a trek in the country. While you could spend a year planning an expedition to wild and lofty places that few would dare attempt, you could also land in Kathmandu with no plans and be on the trail in a matter of days.

Fitness for trekking in Nepal:

If you really want to enjoy your trip, get fit before the trek not on the trek. Arriving in Nepal out of shape having taken no exercise for months, possibly year, is asking for trouble. Nepal, like life in general, is full of ups and downs. Run, walk, swim, bike, do circuits, whatever, but exercise before you go. You don’t need to be marathon fit, but you will enjoy is more if your legs have reasonable muscle tone and your heart-rate has got above its resting 90! A long trek with its ups, and especially its long downs, will short out those with ‘bad’ knees. Wearing a knee support and taking anti-inflammatory drugs is one answer.


Foot problems, such as blisters, are largely a thing of the past with modern lightweight trekking boots, especially if you take time to break in your boots and toughen your feet. Normal foot hygiene also goes a long way to eliminating any problems. Many trekkers hike in training shoes which, although very comfortable, give little in the way of support. Hill-walking is a skill; if you haven’t got it, a good pair of comfortable boots will go a long way towards making it more enjoyable.


The talking point in many trekkers’ lodge and dining tent is Kathmandu Quickstep or, for those arriving from India, Delhi belly. Those who haven’t got it worry about catching it, and those who have it seem to want to share the experiences. Most of the problems are caused through contaminated water is the clean. Much of us contamination, according to local experts, seems to come from faces. Water and sewage in Nepal seem to meet frequently and mix well, but unfortunately they and we don’t. Not without cause did a stricken travelling companion refer to the sub-continent as the ‘Turd World’. Not drinking the water unless you know it has been boiled and filtered, or has had iodine added, will go a long way to keeping you safe. Don’t clean your teeth in your hotel with tab water and be careful of fruit drinks make from squash mixed with untreated water. The lodges are a constant source of infection. Ideal standards of hygiene are impossible to maintain and ensure. After taking care of your own personal hygienic, you pays your money and you takes your chance. Cooked food doesn’t seem to me the problem, and local food such as DalBhat in most cases seems safe. Self-contained and commercial trekking groups, by and large, have more control over hygiene, and hot water for washing hands before meals or outside the toilet tent is a help.

Head, Heart and Altitude:

After attacks on stomach, altitude-related problems seem to be the next major concern or possible cause of difficulty for trekkers. Being in good shape definitely helps, but it is not a guarantee of a trouble-free trip. The greatest provocation is going to high too fast. Going to altitude slowly with adequate rest days coupled with good hydration seems to work for most people. For a few there is a definite altitude ceiling for which the sure seems to be simply to go down. Few treks take you higher than 5,500 meters and rarely for more than a day. However some treks do stay above 5,000 meters for a considerable time and care needs to be taken once there and it getting there. Many trekkers seem to use Diamox (acetazolamide), which helps, but isn’t as good as sound acclimatization. Be aware of the signs of altitude sickness – headaches, being out of breath, loss of appetite, nausea and dizziness are telling you it’s time to stand still or to go down, Listen to your body and descend – things never get better going higher.

Trekker’s/ Climber’s Caugh:

A Nepali dawn is not the sweet trill of warblers on the bough, but a hacking cough and the raucous clearing of throats. It seems to be endemic amongst locals, and is the result, no doubt, or living in a dry, dust-laden atmosphere outside and smoke-filled room inside – the effect is that of a nineteenth – century TB ward. A few days in the dust of Kathmandu, coupled with nights spent in smoky lodges, followed by some hard trekking and heavy breathing in the thin cold air of altitude, often results in sore throats and occasional respiratory infection. Once again, plenty of liquid and throat sweets to lubricate the tubes seem t help, whilst for those who are producing infected green phlegm; it’s time for some antibiotics.

Red Eye:

The dust-laden, smoke-filled atmosphere often also produces eye problems. Personal hygiene helps. Outside, bright sunlight and snow cause their own problems and good sun or snow glasses are the only answer.


This is a common and very painful problem often encountered on the first few days of a trek. Keen to be rid of the pallid complexion of a tourist, trekkers do not pay enough attention to protection the skin against the roasting rays of a sub-tropical sun. Hiking out of Pokhara or Kathmandu can be like a furnace – the number of well-cooked trekkers you see glowing red and later peeling confirms this. The answer is quite simply to use the best sun screen and lip salve available. You will be outside most of the day, and there is plenty of time to tan.

Cold Injury:

On must treks this should not be a problem, but beware, on those treks crossing high snowy passes such as the Throng-La, Tsho-La, and Mingbo-La, it is a very real danger. Firstly, having inadequate footwear is likely to lead, on a pre-dawn start when crossing a pass, to frozen toes and possibly some frost nip. Being caught out in poor weather has certainly caused, in the case of badly-equipped trekkers and porters, hypothermia, frostbite and in some cases death. Being properly equipped and not taking a chance on a crossing in poor weather, especially with porters, is the best advice anyone can give.

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