Nepal

Nepal remains a polpular destination - for trekkers wanting to experience the stunning beauty of the Himalayas, as
well as for its ancient Hindu and Buddhist culture, plus the exotic wildlife of Chitwan national park in the lowlands.
Kathmandu the chaotic capital, is the arrival hub for most.
The following information provides some broad and general guidelines about health risks and recommendations for
this destination.This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues for Nepal

Travellers Diarrhoea
This can destroy a trip, particularly for trekkers, with watery diarrhoea and sometimes vomiting. It is usually caused by
bacteria, such as E.coli, Campylobacter, Salmonella, Shigella, and sometimes by other bugs. Careful food and drink choices
in Kathmandu (no tap water/ice, no undercooked food), as well as hand hygiene, help in prevention. Many travellers go
vegetarian in Nepal to reduce the risk. Whilst trekking, water is usually boiled every morning for the group, however
other measures (water filters or purification tablets) may be used. Diarrhoea is treated with rehydration if mild but if
inconvenient, with a bowel stopper such as loperamide (Gastrostop or Imodium) and if more severe or persistent with
an antibiotic. Sometimes treatment for Giardia or other bugs is required. These medications are best obtained prior to
travel rather than in Nepal, especially since those trekking will be far away from medical care or pharmacies. We stock kits
containing all of these medications.

Respiratory Infections
Many trekkers seem to suffer respiratory infections, which are often contracted in Kathmandu. This is probably due to air
pollution combined with trekkers from around the world bringing new viruses to the crowded environment of the city.
Viral infections are often complicated by bacterial bronchitis or pneumonia, requiring antibiotic treatment, so trekkers
should consider carrying antibiotics specifically to treat these infections as they will be away from medical care. Those
with underlying respiratory disease are particularly at risk. The flu vaccine is often recommended.

Altitude Sickness
High altitude trekkers (those going above 2700m) need to be informed about the risks, prevention and treatment of
altitude sickness, which range from inconvenient mild symptoms to more severe forms affecting the lungs and brain,
which can be life threatening. Certain trekking itineraries (rapid ascent) pose higher risk and some individuals are more
prone. Many trekkers carry specific medication to prevent and treat altitude sickness, and some group treks carry
enclosed pressure bags with a foot pump for immediate relief of symptoms.
For more severe forms, immediate rapid descent, evacuation by helicopter to Kathmandu and specialised medical
treatment may be lifesaving.
The Himalayan Rescue Association provides free lectures on altitude sickness in Kathmandu.

Fitness to Trek and Equipment

Trekkers should ensure they are fully fit for the rigours of trekking - long ascents and descents. Nothing beats several
months of training walking up and down hills at home- in Perth, Kings Park's Jacob's ladder is popular, as well as weekend
treks through the hills. Walking boots should be well worn in. Trekking poles greatly reduce stress on knees, even for
young trekkers. Dress in layers. Most trekking companies provide a list of appropriate equipment and clothing. Be
prepared for extremes in weather at any time of the year - there were recently many deaths from an unseasonal snow
storm in the Annapurna region. A good first aid kit is essential, including dressing, bandages, antiseptic, thermal blanket
and blister treatment. A medication kit should include anti-inflammatory medication, painkillers, treatment for diarrhoea
and respiratory illness and altitude sickness medication.

Animal Bites and Wounds

Monkeys seeking food at the monkey temple in Kathmandu can be aggressive and travellers should not carry food on
them in this location. Dogs are the main transmitters of rabies. Any animal bite or scratch is a risk. Immediate and
thorough irrigation and cleaning of animal wounds is essential, followed by a course of shots. This can be provided at the
CIWEC clinics (see below). Also see more below under Rabies.

Malaria
Malaria is not a risk for most travellers in Nepal as Kathmandu and all the main trekking routes are malaria free. Whilst
there is some theoretic risk in the lowlands of Chitwan National Park in the wet season, no cases have occurred in
travellers.

Security Issues
Political instability has been an issue in Nepal over recent years and demonstrations are best avoided. Keep an eye on the
Australian Governments Smart Traveller website for the latest advice.

Travel Insurance and Seeking Medical Help

Travel insurance is essential. Check for exclusions especially if you are mountaineering or involved in high risk adventure
activities. Helicopter evacuation from mountains is readily available (weather and altitude permitting), but expensive
without insurance (many thousands of dollars). If you need medical help the best place to head are the CIWEC clinics in
Kathmandu or Pokhara:
CIWEC Hospital | Travel Medicine Center
Kathmandu Location:
Lazimpat (Opposite British Embassy) Kathmandu, Nepal
Phone: +977-1-4424111, 4424242, 4435232
Pokhara Location:
Meera Hotel Lane, Lakeside, Pokhara-6, Nepal
Phone: +977-61-463082, 467053

Vaccinations
Routine Vaccinations for all travellers
All international travellers should be up to date or immune to the following as these are transmissable diseases which
may have serious complications:

Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in Nepal in the event of a tetanus prone wound
Recommen ded Vaccinations for most travellers to Nepal

Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Risk is high in
Nepal. Resistance to common antibiotics is also widespread so treatment has become more difficult.

Other vaccinations to consider

Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops the disease if fatal. Travellers should avoid close contact with wild, stray or domestic animals;
in particular dogs, cats, monkeys and bats. Three shots over a minimum of 21 days provide some pre-travel protection,
however medical assistance and further shots are still required after any potential expose.
Japanese Encephalitis, spread by the Culex mosquito,is a rare but very dangerous brain infection. Theoretical risk occurs
in the lowlands during the wet season; however no cases have ever been reported in tourists or expatriates in Nepal
Cholera is rare, but because the vaccine provides some cross protection against common E Coli diarrhoea, vaccination
may be recommended.