Medical Information

This page was added at the request of many people. If you are just looking for a list of the medical supplies I took, please see my gear list. Below I've just touched upon some of the medical issues that are of concern for most trekkers. There are more to these conditions than I've listed here, so please do not use this page as your only reference source. I am not a doctor and don't pretend to be, this is just some helpful information.

Probably the first thing I would recommend doing to take care of your health in Nepal is to purchase a Nepal guidebook. There are many to choose from and every one of them has a pretty good section on healthcare. Perhaps the one that best covers healthcare is Trekking in Nepal, by Stephen Bezruchka. For a guide book, it's just o.k., but Mr Bezruchka worked in Nepal as a physician, so the healthcare section is probably the most comprehensive one available. The Lonely Planet Nepal book is also pretty good in the medical area and is probably the best guidebook out there. After you have read the healthcare section a few times and have a good understanding of it, determine what your tentative itinerary will be and go see your doctor. It's much better to go to your doctor with a knowledge of what you need than to take his advice as your only input. I say this because Nepal is not a common destination and not all doctors have experience with 3rd world countries and mountain medicine. They must know that you will have extremely limited access to medical facilities, if even that. Oh yeah, dental care in Nepal is even worse than their medical care, so go see your dentist too.

Probably the first thing your doctor will do is make sure that all your immunizations are up-to-date. From there, it just depends on your doctor. I told my doctor that I wanted an antibiotic and I even told him which one. He questioned me about its use before he would prescribe it to me and I told him exactly when and how it should be used. I could not have done this if I didn't do my research. For those of you that choose to not see a doctor, I would say you're crazy. I mean, if you can afford a ticket to Nepal, you should be able to afford to go see a doctor. In any event, I would recommend purchasing a small medical mountain sickness handbook before you go or you can buy one in any of the bookstores in Kathmandu or Pokhara. They are small, very small, and can fit in your pack, and you'll probably actually use the darn thing. By reading this book you may decide that you need certain prescription medications, and you will probably be able to purchase some of them, not all, in Kathmandu or Pokhara without seeing a doctor. You don't need to be concerned about the safety of the stuff, it's the real thing (or a very good imitation) and is labeled, and factory sealed. One antibiotic may have several different names, so it's important that you know a few of them since you don't know how the drug will be labeled. In the small medical handbook that I recommended, they will often times list multiple names for the same drug just for this reason. When you go to buy the medication, they are sitting there on the counter just like a grocery store, so you must know exactly what drug you need and the dosage. The other way to get medication is to find a medical store in which you just walk up to the counter and tell the woman what you want. It's also much cheaper to purchase medication in Nepal than in the west. Be sure to let your doctor know what the maximum altitude you will reach is. If you know what trek you'll be doing, you should be able to easily find out this information. Depending on the altitude you reach, It may happen that you'll be susceptible to altitude sickness and you'll want to be prepared for that scenario. Once you arrive in Nepal, be sure to register with your Embassy. They can help arrange helicopter evacuation for worst-case scenarios.

Medical Books - Below you'll find recommendations for good Mountaineering Medical books. I wouldn't take these on a trek since they're too big, but they're great for reference. The first one has been highly recommended by a friend of mine and has great reviews on Amazon. The second also has good reviews on Amazon and looks pretty good. For great recommendations on pocket-sized medical books, as well as recommendations on other books, check out the Himalayan Rescue Association Website.

Medicine for Mountaineering & Other Wilderness Activities
by James Wilkerson
ISBN: 0898863317; Dimensions (in inches): 0.96 x 8.50 x 5.51

Comprehensive Guide to Wilderness & Travel Medicine
by Eric A. Weiss
ISBN: 0965976807; Dimensions (in inches): 0.41 x 6.06 x 4.20

Manang Health Outpost - Manang is located on the Annapurna circuit on the East side of the pass. It's about a 6-day walk to Manang from Besi Sahar (the start of the circuit) and the elevation there is 3,606 m. The reason why they have the health post here is because this is where a lot of people start to feel the effects of the altitude. They conduct daily briefings on AMS and there is also a western doctor here. This health post sells Diamox, Iodine, etc... Unless you have some unique medical condition that requires specialized medication, they should have what you need. This health post also does medical evacuations (for a price), and you'll see the well-used litter laying on the right side of the door when you enter the building. A few hours away from Manang there is an airport where you may be able to get a flight out, but don't count on it. This is more of a rural airport for people with private planes, and a few charter flights every now and then. If you have to be evacuated out, it will probably be by helicopter unless you are very lucky.

Altitude Sickness - Otherwise known as AMS (Acute Mountain Sickness). The good thing about AMS is that it is 100% preventable. The bad thing is that it can kill you, and people do die from it. The way most people get severely sick is by going in a group and not listening to their body. They keep going because they don't want to slow the group down. Either that or the people in the group don't want their schedule to be impacted so they keep going and drag the sick person along. Guides and porters are also susceptible to AMS, so pay attention to their health as well, and look for symptoms since they may not tell you if something is wrong. If you have mild altitude sickness, rest at that elevation until you start to feel better. Do not ascend if you're still feeling bad. If you have severe altitude sickness, descend immediately, and descend with a friend. DO NOT descend alone. With severe AMS you are in no condition to get to a lower elevation by yourself.

Mild AMS Symptoms
Mild Headache
Nausea
Loss of appetite
Mild shortness of breath with minimal exertion
Difficulty sleeping
Dizziness or light-headedness
Mild Weakness
Slight swelling of hands and face

Severe AMS Symptoms
Inability to recover from shortness of breath with rest
Delirium, confusion, and coma
Loss of coordination
Severe, persistent headache
Rapid heart rate after resting - 110 or more beats per minute
Wet, bubbly breathing
Severe coughing spasms that limit activity
Coughing up pinkish or rust-colored sputum
Blueness of face and lips
Low urine output - less that a pint daily
Persistent vomiting
Gross fatigue

Diamox - Diamox is medication that can help your body acclimatize to high elevations. People who are allergic to eggs should not take this medication. Diamox can be purchased in Kathmandu, Pokhara, and Manang (village on the Annapurna Circuit) very cheaply. I'm sure you can also get it at other health posts in Nepal, but I don't know where those are. These are the ones I'm 100% sure about.

Ciprofloxacin - It's not a very good idea to venture out on the trail without an antibiotic. There are a few antibiotics that have built up resistance in Nepal, this one hasn't, yet. I don't recall if this can be purchased there or not.

Acidophilus - This puts additional floura/bacteria into your digestive tract and is taken as a preventative measure. It can be taken in tablet form and the dosage is 1 per day. The additional floura in your tract helps your body adapt since you will be exposing yourself to many things that you're body isn't used to. Taking this tablet is equivalent to eating yogurt everyday, which isn't always possible while trekking. Typically, females will know about the benefits of eating yogurt since it has been known to help in certain female biological problems. Although, it's hard to tell if this will prevent you from becoming sick since if it works you'll get sick less or not at all. I took it as a recommendation by a physician and it can be purchased without a prescription. If you start taking antibiotics you'll want to stop taking the acidophilus. It can not be purchased in Nepal.

Vitamin C - (self dissolving tablets, like Alka-Seltzer) I originally purchased these to put into my water bottle to add a citrus taste and help kill the taste of the iodine tablets. Unfortunately, they came in a large bottle and I kept them in my pack, thus never using them. I also got used to the iodine-water taste and once that happened, there was no need for the Vitamin C. However, when I started feeling sick, I did start taking the Vitamin C to help me get over my sickness. If I could do it all over, I would leave these at home and just take Vitamin C in tablet form for everyday, just like the acidophilus. I did not see this available in Nepal.

Oral Rehydration Salts - Most trekkers will suffer some diarrhea while in Nepal and this is common. If the diarrhea continues, dehydration can become a very serious medical problem. If you do get dehydrated, rehydration salts can help you get better faster than by just drinking plain water. I purchased some very good rehydration salts in the U.S. prior to leaving for Nepal and paid an outrageous amount for them. I think they were $34 from REI. You can purchase these in Nepal for about 1/34 of that price, but the only downside is that the ones you buy in Nepal taste absolutely horrid. It's your call, but either way, make sure you get some before hitting the trail.

Giardiasis - Giardiasis is a virus that can be found in the water in Nepal and is easily killed by iodine or a good water filter (check to see what it removes). Chlorine tablets can not kill the giardia virus. Certain times of year are better than others when it comes to giardia infections. During the monsoon, the rains wash everything into the water sources and your chance of a giardia infection rises considerably. If you trek before or after the monsoon, your chances decrease greatly. When I went kayaking I noticed that I drank a large amount of water involuntarily. Knowing that, if I were to go rafting or kayaking again, I would probably take the medicine for giardia. Also, when you raft or kayak you are even more distant from civilization than normal, thus the need for an even more complete medical kit. All the rafting companies carry a medical kit, but I'd just rather be 100% sure that I have anything I may need. The treatment for giardia is Tinidazole and this is easily purchased in Kathmandu, Pokhara, or Manang.

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